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Neonatal ventilation with a manikin model and two novel PEEP valves without an external gas source
  1. Monica Thallinger1,
  2. Hege Langli Ersdal2,3,
  3. Colin Morley4,
  4. Carolyn Purington5,
  5. Øystein Gomo5,
  6. Estomih Mduma6,
  7. Joar Eilevstjønn5,
  8. Ketil Størdal7,8
  1. 1Faculty of Medicine, Institute of Clinical Medicine, Institute for Experimental Medical Research, University of Oslo, Oslo, Norway
  2. 2SAFER, Stavanger, Norway
  3. 3Department of Anaesthesiology & Intensive Care, Stavanger University Hospital, Stavanger, Norway
  4. 4Department of Obstetrics & Gynaecology, University of Cambridge, Cambridge, UK
  5. 5Department of Strategic Research, Laerdal Medical AS, Stavanger, Norway
  6. 6Research Centre, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania
  7. 7Department of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
  8. 8Ostfold Hospital Trust, Fredrikstad, Norway
  1. Correspondence to Dr Monica Thallinger, Institute of Clinical Medicine, Institute for Experimental Medical Research, Faculty of Medicine, University of Oslo, P.O. Box 4956 Nydalen, Oslo 0424, Norway; monica.thallinger{at}


Objective Positive end expiratory pressure (PEEP) is beneficial when ventilating preterm newborns. The aim was to study whether inexperienced providers were able to generate PEEP during simulated neonatal ventilation, using two novel prototype PEEP valves, on a self-inflating bag without an external gas source.

Design Forty-six nursing students in Tanzania were trained in ventilation with a new Laerdal Upright resuscitator and mask on a NeoNatalie manikin with a newborn resuscitation monitor. Ventilation was studied with and without PEEP valve 1 (anticipated level 4–5 cm H2O) and with and without PEEP valve 2 (anticipated level 9–10 cm H2O) in random order for normal and low ‘lung’ compliance. The PEEP valves were concave silicone valves with a small slit that would open to let expiratory air out.

Results Mean PEEP with PEEP1 was 4.4 cm H2O (SD 2.2) and with PEEP2 was 4.9 cm H2O (SD 3.1). PEEP ≥4 cm H2O was generated with 70% of inflations with PEEP1 and 65% with PEEP2. Mean airway pressure was 16.3 cm H2O with both PEEP valves compared with 14.2 without PEEP (p<0.001). Mean mask leak was similar with and without PEEP (48% with PEEP1, 58% with PEEP2, 55% without PEEP). Mask leak and PEEP were inversely correlated. Findings with normal and low ‘lung’ compliance were similar.

Conclusions PEEP between 4 cm H2O and 5 cm H2O was achieved when ventilating a neonatal manikin using a self-inflating bag and novel PEEP valves. Valves that can generate PEEP without external gas sources may aid resuscitation in resource-limited settings.

  • Neonatology
  • Resuscitation

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