The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Evaluation of the Neopuff infant resuscitator compared to A conventional ANESTHESIA BAG resuscitator in a simulated premature neonate

 Tom Blackson, BS, RRT1, 2, Joseph A. Ciarlo, BA, RRT1, 2, Tom DelleDonne BS, RRT1, 2,   Christiana Care Health System, 2Delaware Technical and Community College, Wilmington Campus, DE. 

Background: Neonatal resuscitation guidelines allow for use of both anesthesia type (A) and "t-piece" type (T) resuscitators for manual ventilation of premature neonates. Previous studies have identified that the consistency of ventilation as well as the deviation from target ventilation parameters differs depending on the type of resuscitator employed.

Purpose: To compare the consistency of ventilation provided to an infant lung model by RNs and RCPs using both "A" and "T" type resuscitators. A secondary goal is to determine if an independent pacing device improves the consistency of delivered ventilatory frequency (f) compared to self-pacing.

Materials/ Methods: A premature neonate was simulated with a test lung model for this study: compliance = 1 mL/cm H2O and a 2.5 mm ID ETT was used to simulate airway resistance. Twenty one RNs and 17 RCPs were recruited to manually ventilate the test model with the "A" and "T" resuscitators to target a PIP = 20 cm H2O, PEEP = 5 cm H2O, f = 40 breaths/min., and a TI = 0.4 sec. A differential pressure transducer, (CO2SMO, Novametrix, Wallingford, PA), was positioned between the ETT and the manual resuscitator to measure f, PIP, PEEP, TI, VT, PIFR, and mean airway pressure (Paw). Both resuscitators were powered with 10 L/min. of O2. Each participant was inserviced on the use of the "T" resuscitator, not to exceed 15 min., followed by an additional 15 min. maximum time to practice with either resuscitator prior to data collection.  Inservicing on the "A" resuscitator was available to all participants but was deferred due to familiarity with the device. Each participant manually ventilated the model for one minute with each resuscitator during data collection. In a separate test, each participant ventilated the test model a third time with the same ventilation targets while aided by a metronome programmed to provide an audible and visible cue at a f of 40/min.  Participants were instructed to use the resuscitator of their choice for this test. All participants completed a questionnaire at the conclusion of the trial that addressed credentials, years of experience, and resuscitator preference.

Results: Paw and PIFR were significantly higher in the "T" resuscitator group when compared to the "A" group, (p < 0.001) with no significant difference in TI between groups, (p > 0.05). The VT and PEEP were not significantly different between groups (p > 0.05). PIP was statistically lower in the "A" group when compared to the "T" group, (p < 0.001). The use of a metronome for pacing significantly improved the accuracy and consistency of f delivered when compared to the "A" group (p < 0.05), but had no significant effect when used with the "T" resuscitator, (p > 0.05). The "T" resuscitator was preferred over the "A" resuscitator by > 80% of participants.

Parameter "A"     (± SEM) "T"     (± SEM) p Value
f          (B/min.) 45.13         (2.72) 37.08         (2.04) < 0.001*
VT           (mL) 15.13         (0.25) 15.04         (0.35) > 0.05
PIP      (cm H2O) 18.53         (0.32) 19.74         (0.14) < 0.001*
PEEP  (cm H2O)  3.39          (0.26)   3.77         (0.15) > 0.05
Paw     (cm H2O)  8.22          (0.22) 10.54         (0.26) < 0.001*
PIF      (L/min.)  3.49          (0.21)   5.91         (0.08) < 0.001*
TI         (sec.)  0.65          (0.04)   0.67         (0.04) > 0.05

Conclusions: The "T" resuscitator consistently delivered a more accurate and precise PIP than the "A" resuscitator in this model. Increased PIFR delivered via the "T" device contributes to the increased Paw demonstrated in this model and may be of clinical significance with regard to work of breathing and oxygenation in premature neonates. A timing cue for f may be of benefit when the "A" device is used clinically. Further evaluation is warranted.

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