ABSTRACT
BACKGROUND: International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing 'adequate' chest excursion lacks objectivity. AIM: It was the aim of this study to test the accuracy in the assessment of 'adequate' chest excursion by measuring intra- and inter-observer variability of participants during simulated neonatal resuscitation. METHODS: Thirty-seven staff members (8 neonatologists, 8 registrars, 21 nurses) of the Neonatal Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands, ventilated 2 different intubated, leak-free manikins at 2 attempts, each with a different compliance. Blinded to the manometer, participants could change the peak inflation pressure until chest movement was adequate according to their perception. Inflating pressures were recorded. RESULTS: According to the participants, a median (interquartile range) pressure of 18 cm H2O (16-22) at the first and 18 cm H2O (16-25) at the second attempt were needed to reach adequate chest excursion in the Laerdal manikin. The HAL manikin needed 26 cm H2O (19-31) and 24 cm H2O (22-33), respectively. The inter-observer coefficient of variance was 30% with the Laerdal manikin at both attempts, and 35 and 40% with the HAL manikin, respectively. The intra-observer coefficient of variance was 15% (8-23) with the Laerdal and 13% (9-20) with the HAL manikin. In both manikins and attempts, no significant differences in pressures and variances of pressures between the 3 groups were found. CONCLUSION: 'Adequate' chest excursion is a subjective parameter for guidance of appropriate ventilation during neonatal resuscitation.
Subject(s)
Infant, Newborn, Diseases/therapy , Resuscitation/methods , Resuscitation/standards , Chest Wall Oscillation/methods , Chest Wall Oscillation/standards , Clinical Competence , Guideline Adherence/standards , Health Knowledge, Attitudes, Practice , Humans , Infant, Newborn , Manikins , Medical Staff, Hospital , Neonatology , Observer Variation , Reproducibility of Results , Resuscitation/statistics & numerical data , Thorax , Ventilators, Mechanical , WorkforceABSTRACT
Coinciding with the Annual Meeting of the Pediatric Academic Societies (PAS) last May 2008 in Honolulu (Hawaii, USA), Professor Colin Morley and his colleagues (University of Melbourne, Australia) held a Workshop on Research in Neonatal Resuscitation. Experts in the field presented their results and future projects over 2 days. The subjects presented during the workshop were: oxygen, air and oximetry; when and where to apply surfactant; neonatal resuscitation research techniques; teaching neonatal resuscitation; cellular physiology and biology; CPAP/PEEP/prolonged inspiration; video recording during resuscitation. Sessions were characterized by an interactive discussion. Our intention is to tell about some of the most innovative aspects that might interest our neonatal colleagues who did not have the opportunity to attend the meeting. As much of the information contained in this article is on experiments based, we recommend the reader not to consider it for immediate application in clinical practice until it has been validated by sufficient proof.
Subject(s)
Resuscitation , Air , Animals , Clinical Trials as Topic , Continuous Positive Airway Pressure , Humans , Infant, Newborn , Oximetry , Oxygen/administration & dosage , Positive-Pressure Respiration , Resuscitation/education , Resuscitation/methodsABSTRACT
En mayo de 2008 y en coincidencia con la reunión anual de las Pediatric Academic Societies, se realizó en Honolulu (Hawaii, EE. UU.) un simposio sobre Investigación en reanimación neonatal, organizado por el profesor Colin Morley (Universidad de Melbourne, Australia). Durante 2 días, expertos en el área de la investigación en reanimación neonatal presentaron sus resultados y proyectos. Las áreas estudiadas fueron oxígeno, aire y oximetría; cuándo y dónde aplicar el agente tensioactivo; técnicas de investigación en reanimación neonatal; enseñanza de reanimación neonatal; fisiología y biología celulares; presión positiva continua en la vía respiratoria, presión positiva final espiratoria e inspiración prolongada, y grabación mediante vídeo de la reanimación. El simposio se caracterizó por una discusión activa. En este artículo se relatan aquellos aspectos más novedosos que pueden ser de interés para los neonatólogos que no tuvieron la oportunidad de asistir. Ya que mucha de la información que se presenta en este artículo procede del campo experimental, es recomendable que el lector no la traslade directamente a la práctica clínica hasta que haya sido avalada por pruebas suficientes (AU)
Coinciding with the Annual Meeting of the Pediatric Academic Societies (PAS) last May 2008 in Honolulu (Hawaii, USA), Professor Colin Morley and his colleagues (University of Melbourne, Australia) held a Workshop on Research in Neonatal Resuscitation. Experts in the field presented their results and future projects over 2 days. The subjects presented during the workshop were: oxygen, air and oximetry; when and where to apply surfactant; neonatal resuscitation research techniques; teaching neonatal resuscitation; cellular physiology and biology; CPAP/PEEP/prolonged inspiration; video recording during resuscitation. Sessions were characterized by an interactive discussion. Our intention is to tell about some of the most innovative aspects that might interest our neonatal colleagues who did not have the opportunity to attend the meeting. As much of the information contained in this article is on experiments based, we recommend the reader not to consider it for immediate application in clinical practice until it has been validated by sufficient proof (AU)
