The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

Comparison of Manual Ventilation using the Neopuff Infant Resuscitator and Flow Inflating Anesthesia Bag


Kathleen Deakins RRT-NPS, Stephen Clark RRT-NPS, Timothy Myers RRT-NPS. Rainbow Babies & Children's Hospital. Cleveland, OH.

Introduction: Manual ventilation is a task typically performed in the newborn nursery or delivery room by a respiratory therapist, nurse, physician, or nurse practitioner during suctioning or resuscitation, or by a paramedic during neonatal transport. The Neopuff Infant Resuscitator, a manually cycled, pressure limited manually triggered device was more consistent and preferred method of manual ventilation during simulated transport situations according to Respiratory Therapists in a previous study (Resp Care 2001: 46(10) 1133). This study was designed to compare the accuracy and consistency of manual ventilation using a flow inflating resuscitation bag and the Neopuff infant resuscitator when performed by various caregivers involved in neonatal resuscitation using a set of predetermined parameters.

Methods: 121 caregivers including staff and student respiratory therapists, neonatal nurse practitioners, NICU nurses, neonatalogists or residents and paramedics involved in critical care transport were asked to perform manual ventilation using the Neopuff Infant Resuscitator and a flow inflating anesthesia bag. The simulated target parameters were: frequency (f) 30 bpm, peak inspiratory pressure (pip) 25 cm H20 and PEEP +5 cm H20. All staff had the option to use an aneroid manometer placed in line with the flow inflating resuscitation bag to measure delivered pressures. The flow inflating resuscitation bag and the Neopuff infant resuscitator circuit were attached to a 2.5 mm endotracheal tube connected to an Infant Star test lung with a preset compliance of 1 ml/cm H20 for each portion of the study. Simulated target parameters were measured by the Meteor (Nellcor Puritan Bennett), a hand held pulmonary mechanics monitor using the flow sensor in line between each resuscitation device and the endotracheal tube and test lung.

RESULTS: Data were recorded as mean values for each parameter at the conclusion of the 30-bpm cycle. Accuracy in achieving targeted parameters was evaluated by determining mean pressure values subtracted from targeted values. Unpaired t tests were used to compare mean values for consistency and error for the Neopuff and flow inflating resuscitation bag for manual ventilation. Statistical significance was set at p <0.05. A summary of mean values + standard deviations and resulting p values are listed for targeted parameters on all 121 participants in the chart below.

    Consistency Error Resulting p value
  Target Values Flow Inflating Neopuff Flow Inflating Neopuff
RR bpm 30 36.9+ 9.4 32.3 + 7.8 6.9 2.3 <0.0001
IT sec N/A 0.6 + 0.2 0.7 + 0.3 N/A N/A 0.02
PIP cm H20 25 24.6 + 3.1 25.2 + 0.9 -0.4 0.2 0.03
PEEP cmH20 5 5.1 + 2.5 5.2 + 1.0 0.1 0.2 0.57
Vt mL N/A 45.3 + 9.6 49.1 + 7.2 N/A N/A 0.0001


Conclusion: In this simulation of manual ventilation, the Neopuff Infant Resuscitator provided more accurate and consistent respiratory rates and peak inspiratory pressures than the flow-inflating bag. Using the flow-inflating bag resulted in significantly shorter inspiratory times and smaller tidal volumes. While the Neopuff Infant Resuscitator provides a more reliable and consistent rate and peak pressure, care should be taken to minimize the potential for barotrauma from prolonged inspiratory times and the resulting higher tidal volumes.

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