Artículos de revistas
An Evaluation Of Peak Inspiratory Pressure, Tidal Volume, And Ventilatory Frequency During Ventilation With A Neonatal Self-inflating Bag Resuscitator
Registro en:
Respiratory Care. , v. 57, n. 4, p. 525 - 530, 2012.
201324
10.4187/respcare.01423
2-s2.0-84860505664
Autor
Bassani M.A.
Filho F.M.
Coppo M.R.C.
Marba S.T.M.
Institución
Resumen
Although the self-inflating bag is widely used in the hospital setting, variability of delivered ventilatory parameters is usually high, which might result in both hypoventilation and lung injury. The aims of this study were to assess possible sources of the high variability and to evaluate the adequacy of obtained values in relation to the recommended values for neonatal resuscitation. METHODS: This was an experimental study in which 172 health professionals (physicians, resident physicians, physiotherapists, nurses, and nursing technicians) who work with neonatal intensive care manually ventilated a test lung (adjusted to simulate the lungs of an intubated term newborn) with a self-inflating bag in 5 different handling techniques, using 10, 5, 4, 3, and 2 fingers. Delivered values of peak inspiratory pressure (PIP), tidal volume (V T), and ventilatory frequency (f) were compared, taking into account the different handling modalities and professions by analysis of variance for repeated measures. Chi-square, the Friedman test and the Fisher exact tests were performed to compare the delivered and standard values. RESULTS: PIP and V T were significantly affected by the handling technique, with higher values for a greater number of fingers used for ventilation. Profession also influenced VT and f significantly: physiotherapists tended to deliver higher volumes and lower rates. Nevertheless, we observed high variability of all studied ventilatory parameters and overall inadequacy of obtained values. Most volunteers delivered excessive pressures and volumes at insufficient ventilatory frequency. CONCLUSIONS: Delivered values seem to depend on operators' individual and professional differences, as well as on the number of fingers used to compress the bag. However, from the clinical point of view, it is important to point out the high occurrence of inadequate delivered values, regardless of handling technique and profession. © 2012 Daedalus Enterprises. 57 4 525 530 Almeida, M.F., Guinsburg, R., Controversies in neonatal resuscitation (2001) J Pediatr (Rio J), 77 (SUPPL. 1), pp. S41-S52 2005 international consensus on cardiopulmonary rescue and emergency cardiovascular care sciences with treatment recommendations. Part 7: Neonatal resuscitation (2005) Resuscitation, 67 (2-3), pp. 293-303. , International Liaison Committee on Resuscitation Guinsburg, G., Almeida, M.F., Miyoshi, M.H., (2009) Manual de Reanimação Neonatal, pp. 125-238. , 5th edition, American Heart Association American Academy of Pediatrics Universidade Federal de São Paulo, editores, São Paulo: Editora Universidade Federal de São Paulo Book in Portugese Hess, D., Goff, G., Johnson, K., The effect of hand size, resuscitator brand, and use of two hands on volumes delivered during adult bagvalve ventilation (1989) Respir Care, 34 (9), pp. 805-810 Hussey, S.G., Ryan, C.A., Murphy, B.P., Comparison of three manual ventilation devices using an intubated mannequin (2004) Arch Dis Child Fetal Neonatal Ed, 89 (3), pp. 490-493 Augustine, J.A., Seidel, D.R., McCabe, J.B., Ventilation performance using a self-inflating anesthesia bag: Effect of operator characteristics (1987) Am J Emerg Med, 5 (4), pp. 267-270 Hess, D., Spahr, C., An evaluation of volumes delivered by selected adult disposable resuscitators: The effects of hand size, number of hands used and use of disposable medical gloves (1990) Respir Care, 35 (8), pp. 800-805 Hess, D., Goff, G., The effects of two-hand versus one-hand ventilation on volumes delivered during bag-valve ventilation at various resistances end compliances (1987) Respir Care, 32 (11), pp. 1025-1028 Hess, D., Simmons, M., Blaukovitch, S., Lightner, D., Doyle, T., An evaluation of the effects of fatigue, impedance, and use of two hands on volumes delivered during bag-valve ventilation (1993) Respir Care, 38 (3), pp. 271-275 Kain, Z.N., Berde, C.B., Benjamin, P.K., Thompson, J.E., Performance of pediatric resuscitation bags assessed with an infant lung simulator (1993) Anesth Analg, 77 (2), pp. 261-264 Bassani, M.A., Mezzacappa Filho, F., Coppo, M.R.C., Marba, S.T.M., Peak pressure and tidal volume are influenced by how the neonatal selfinflating bag is handled (2009) J Pediatr (Rio J), 85 (3), pp. 217-222 Law, G.D., Effect of hand size on VE, VT, and FiO2 during manual resuscitation (abstract) (1982) Respir Care, 27 (10), pp. 1236-1238 Finer, N.N., Rich, W., Craft, A., Henderson, C., Comparison of methods of bag and mask ventilation for neonatal resuscitation (2001) Resuscitation, 49 (3), pp. 299-305 Denehy, L., The use of manual hyperinflation in airway clearance (1999) Eur Respir J, 14 (4), pp. 958-965 McCarren, B., Chow, C.M., Manual hyperinflation: A description of the technique (1996) Aust J Physiother, 42 (3), pp. 203-208 Turki, M., Young, M., Wagers, S.S., Bates, J.H.T., Peak pressures during manual ventilation (2005) Respir Care, 50 (3), pp. 340-344 Rezende, J.G., Menezes, C.G., Paula, A.M.C., Ferreira, A.C.P., Zaconeta, C.A.M., Silva, C.A.M., Avaliação do pico de pressão e de frequência respiratória durante o uso de balão auto-inflável em um modelo de pulmão neonatal (2006) J Pediatr (Rio J), 82 (5), pp. 359-364. , Article in Portugese Rezende, J.G., Zaconeta, C.A.M., Ferreira, A.C.P., Silva, C.A.M., Rodrigues, M.P., Rebello, C.M., Tavares, P., Avaliação do pico de pressão, do volume corrente e da frequência respiratória durante ventilação de carneiros prematuros, utilizando balão auto-inflável (2006) J Pediatr (Rio J), 82 (4), pp. 279-283. , Article in Portugese (2007) Standard specifications for performance and safety requirements for resuscitators intended for use with humans, , American Society for Testing and Materials, Designation: F920-93. Philadelphia: ASTM 1999. (Withdrawn) Paradine, C.G., Rivett, B.H.P., (1974) Métodos estatísticos para tecnologias, p. 337. , São Paulo: Polígono da Editora da Universidade de São Paulo, Article in Portugese Wyllie, J., Resuscitation of the term and premature baby (2008) Paediatr Child Health, 18 (4), pp. 166-171 Spitzer, A.R., Fox, W.W., Positive-pressure ventilation: Pressure-limited and time-cycled ventilators (1996) Assisted ventilation of the neonate, pp. 167-186. , In: Goldsmith JP, Karotkin EH, editors, Philadelphia: Saunders Guinsburg, R., Almeida, M.F.B., Miyoshi, M.H., Reanimação do recémnascido em sala de parto (2004) Diagnóstico e tratamento em neonatologia, pp. 31-37. , In: Kopelman BI, Santos AMN, Goulart AL, Almeida MFB, Miyoshi MH, Guinsburg R, editores, São Paulo: Atheneu;:. Book in Portugese Ganga-Zandzou, P.S., Diependaele, J.F., Riou, Y., Klosowski, S., Rakza, T., Logier, R., Lequien, P., La ventilation à Ambúchez nouveau-né: Une simple question de doigté? (1996) Arch Pédiatr, 3 (12), pp. 1270-1272. , Article in French Roehr, C.C., Kelm, M., Fischer, H.S., Bührer, C., Schmalisch, G., Proquitté, H., Manual ventilation devices in neonatal resuscitation: Tidal volume and positive pressure-provision (2010) Resuscitation, 81 (2), pp. 202-205 Goldstein, B., Catlin, E., Vetere, J., Arguin, L., The role of in-line manometers in minimizing peak and mean airway pressure during the hand-regulated ventilation of newborn infants (1989) Respir Care, 34 (1), pp. 23-27 Finer, N.N., Barrington, K.J., Al-Fadley, F., Peters, K.L., Limitations of self-inflating resuscitators (1986) Pediatrics, 77 (3), pp. 417-420 Godoy, A.C., Vieira, R.J., de Capitani, E.M., Alterações de pico inspiratório e do volume corrente fornecidos por reanimadores manuais com balão auto-inflável em função do fluxo de entrada de oxigênio utilizado (2008) J Bras Pneumol, 34 (10), pp. 817-821. , Article in Portugese McHale, S., Thomas, M., Hayden, E., Bergin, K., McCallion, N., Molloy, E.J., Variation in inspiratory time and tidal volume with T-piece neonatal resuscitator: Association with operator experience and distraction (2008) Resuscitation, 79 (2), pp. 230-233