Original Article
Oxygen delivery using neonatal self-inflating resuscitation bags without a reservoir
1 Hospital Sant Joan de Deu, Spain;
2 The Royal Women's Hospital, Australia
Correspondence to: Marta Thio, Newborn Research, The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia; mthio{at}hsjdbcn.org
Accepted 3 September 2009
Background: Guidelines recommend avoidance of excessive oxygen administration during neonatal resuscitation. Blenders are used in some but not all hospitals. It has been suggested that self-inflating bags without a reservoir deliver around 40% oxygen and could be used to provide an inexpensive and effective technique of avoiding oxygen toxicity.
Objective: To explore how much oxygen is delivered when using two different brands of neonatal self-inflating resuscitation bags without a reservoir.
Methods: In a benchtop setting, the smallest non-disposable self-inflating bags from the Laerdal® and Ambu® ranges were tested. Oxygen concentration delivered by these devices under a variety of conditions was measured. 108 combinations of oxygen flow rates (10, 5 to 1 L/min), ventilation rates (30, 60, 100 inflations/min) and peak inspiratory pressure ranges (20-25 cmH2O, 35-40 cmH2O or pop-off valve range, 55-60 cmH2O) were tested.
Results: Delivered oxygen concentration varied depending on 3 parameters: gas flow rate, ventilatory rate and pressure. At a pressure of 20-25 cmH2O, mean oxygen concentration delivered by both bags exceeded 70% at any gas flow rate except for 1 L/min (where delivered oxygen concentration was 60-70%). When the pop-off valve was opened at 35-40 cmH20, oxygen concentrations fell to 30%-45% at gas flow rates 
2 L/min. The Ambu bag delivered a lower oxygen concentration than the Laerdal bag but this difference was not clinically important.
Conclusion: When using the Laerdal and Ambu infant resuscitation self-inflating bags without a reservoir, delivered oxygen concentration is greater than 70% for currently recommended flow and pressure settings.
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