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The effectiveness of Ambu neonatal self-inflating bag to provide consistent positive end-expiratory pressure
  1. Mark Tracy1,2,
  2. Dharmesh Shah1,3,
  3. Archana Priyadarshi1,3,
  4. Murray Hinder1,3
  1. 1 Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2Department of Paediatrics and Child Health, Sydney University, Westmead, New South Wales, Australia
  3. 3Sydney University, New South Wales, Australia
  1. Correspondence to Dr Mark Tracy, Department of Paediatrics and Child Health, Sydney University, P.O. Box 533, Wentworthville, NSW 2145, Australia; mark.tracy{at}sydney.edu.au

Abstract

Background The self-inflating bag (SIB) is the most common device used to resuscitate newborn infants worldwide. Delivering positive end-expiratory pressure (PEEP) may be important in infant resuscitation and limited research using one brand (Laerdal) SIB has led to international guidelines stating SIBs ‘often deliver inconsistent positive end-expiratory pressure’.

Aim To measure delivered PEEP using disposable and reusable Ambu SIBs fitted with Ambu PEEP valve and manometer comparing different rates of 20, 40 and 60 inflations per minute (IPM) and test lung compliance.

Design Three experienced neonatal medical staff provided positive pressure ventilation each using different disposable and reusable Ambu SIBs, targeting peak inflation pressure of 30–35 cm H2O at three different set PEEP levels of 5, 7.5 and 10 cm H2O on test lungs of compliance of 0.5 and 3.0 mL/cm H2O. Inflation data were captured with Florian Monitor and analysed by analysis of variance for repeated measures.

Results A total of 3265 inflations were analysed. The delivered PEEP was rate and lung compliance dependent. At set PEEP of 5 cm H2O, the adjusted measured PEEP was 3.6, 4.4 and 4.8 cm H2O at rates 20, 40 and 60 IPM, respectively, while at set PEEP of 10 cm H2O, the adjusted measured PEEP was 7.0, 8.8 and 9.8 cm H2O. The delivered PEEP was statistically higher with more compliant test lungs.

Conclusions The Ambu SIB with Ambu PEEP valve can deliver consistent mean levels of PEEP close to the operator set PEEP. The performance of SIB with PEEP valves is likely brand specific and requires further evaluation.

  • newborn
  • self-inflating bag
  • Resuscitation
  • PEEP
  • peak inspiratory pressure

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