2001 OPEN FORUM Abstracts
Evaluation of Manual Ventilation Using the Neopuff Infant Resuscitator During Transport of the Premature Infant
Nancy Johnson RRT, KathleenDeakins RRT, Robert Chatburn RRT FAARC, and Timothy Myers BS RRT. Rainbow Babies& Children?s Hospital, Cleveland, OH
Introduction: Manual ventilationis a daily task performed in the Neonatal Intensive Care Unit (NICU) duringsuctioning, resuscitation and transport. The Neopuff Infant Resuscitator (Fisher& Paykel Inc.) is manually triggered, pressure limited and manually cycledand is pneumatically powered by a flowmeter. One potential use for this deviceis to transport preterm infants requiring mechanical ventilation. A previousstudy by Keenan et al (Resp Care 1999, 44 (10), 1252) demonstrated variabilityof tidal volumes (Vt) and PEEP?s with a pediatric-aged, simulation of anesthesiabag ventilation. This study was designed to compare the accuracy and consistencyof manual ventilation in achieving a set of predefined ventilatory parametersusing the Neopuff reuscitator versus conventional anesthesia bag ventilationduring simulated patient transport.
Methods: An incubator (AirshieldsIsolette) was equipped to simulate a typical NICU transport with an Infant Startest lung serving as a patient. Nineteen staff therapists were asked to ventilatethe test lung at predefined target parameters: peak inspiratory pressure (PIP)of 22 cmH20, PEEP 5 cmH20, respiratory rate (RR) of 30breaths/minute (bpm), and 100% Fi02 using an anesthesia bag and theNeopuff Resuscitator. For anesthesia bag ventilation, a pressure monitor wasavailable for use at the therapist?s discretion. The simulated patient?s ventilatoryparameters were monitored by two hand held pulmonary mechanics monitors: NovametrixVent Check (Novametrix Medical Systems Inc.) and the Breath Tracker 1705 (Core-MPrecision Instruments Inc.), which also measured the delivered tidal volume(Vt). The length of the simulated transport was approximately 125 feet. Datawere recorded as the highest and lowest measured values for each parameter duringthe transport. The consistency of the data for each parameter was estimatedby the range (highest value minus lowest value). Accuracy in achieving and maintainingventilatory parameters was evaluated as error (error = mean measured value ?target value). The mean value for each parameter was estimated as the rangedivided by 2. Unpaired t-tests were used to compare mean values for consistencyand error between anesthesia bag versus Neopuff (significance at p< 0.05)manual ventilation.
Results: The data below summarizethe performance of all 19 therapists as mean ± SD:
|Bag & Mask||Neopuff||p||Bag & Mask||Neopuff||p|
|PIP (cmH20)||2.2± 2.4||1.7 ± 1.6||0.32||24.2 ± 2.4||23.7 ± 1.5||0.40|
|PEEP (cmH20)||0.4 ± 0.9||0.3 ± 0.8||0.01||4.6 ± 0.9||5.3 ± 0.8||0.01|
|RR (bpm)||7.6 ± 10.4||1.5 ± 9.8||0.07||37.6 ± 10.4||31.5 ± 9.8||0.07|
|Vt (mL)||N/A||N/A||N/A||23.1 ± 3.8||20.9 ± 2.2||0.05|
Conclusion:In this simulation of transport ventilation, the Neopuff Infant resuscitatorprovided more accurate and consistent Vt and levels of PEEP. Study participantsviewed the Neopuff resuscitator as an easier and more consistent method of manuallyventilating infants during transport because it required less manipulation ofthe endotracheal tube while consistent pressures were maintained.