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.