Two-minute training for improving neonatal bag and mask ventilation.

Jeroen J Van Vonderen,Arjan B Te Pas,Sascha Kraaij,Ruben S Witlox,Edgardo Szyld

doi:10.1371/journal.pone.0109049

Abstract

ObjectivesTo test effectivity of a two-minute training consisting of a few key-points in ventilation using the self-inflating bag (SIB).Study DesignExperienced and inexperienced caregivers were asked to mask ventilate a leak free manikin using the SIB before and after the training. Mask leak and pressures were measured using respiratory function monitoring. Pressures above 35 cm H2O were considered excessive. Parameters were compared using a Wilcoxon non-parametric test.ResultsBefore and after the short training, experienced caregivers had minimal median (IQR) mask leak (14 (3-75) vs. 3 (0-53)%; p<0.01). Inexperienced users had large leak which reduced from 51 (7-91)% before to 11 (2-71)% after training (p<0.01). Pressures above 35 cm H2O hardly occurred in experienced caregivers (0 (0-5) vs. 0 (0-0)%; ns). In inexperienced caregivers this frequently occurred but decreased considerably after training (94 (46-100) vs. 2 (0-70)%; p<0.01).ConclusionA two-minute training of bag and mask ventilation was effective. This training could be incorporated into any training program.

Highlights

World-wide an estimated three to six percent of newborn infants need assisted positive pressure ventilation (PPV) at birth [1]
Pressures above 35 cm H2O hardly occurred in experienced caregivers (0 (0-5) vs. 0 (0-0)%; ns)
Achieving effective manual ventilation can be difficult [2,3,4,5,6] because most clinicians are not aware when mask leak or airway obstruction occurs and excessive peak inflation pressures (PIP) are delivered [3,7,8]

Summary

Introduction

World-wide an estimated three to six percent of newborn infants need assisted positive pressure ventilation (PPV) at birth [1]. Achieving effective manual ventilation can be difficult [2,3,4,5,6] because most clinicians are not aware when mask leak or airway obstruction occurs and excessive peak inflation pressures (PIP) are delivered (above 35 cm H2O) [3,7,8]. The most urgent need for improving the skills of basic neonatal resuscitative actions is in low and middle-income countries where the burden of prenatal deaths and morbidity is considered to be the highest and 99% of neonatal deaths occur [1,9]. In guidelines a self-inflating bag (SIB) and mask are recommended for neonatal resuscitation [11]. With a SIB more variable pressures are given, which can lead to either inadequate or excessive volumes delivered to the lung [13] which may cause lung injury [2,3,4,5,6,14]

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Conclusion