RT Journal Article
SR Electronic
T1 Neonatal ventilation with a manikin model and two novel PEEP valves without an external gas source
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F208
OP F213
DO 10.1136/archdischild-2016-310955
VO 102
IS 3
A1 Monica Thallinger
A1 Hege Langli Ersdal
A1 Colin Morley
A1 Carolyn Purington
A1 Øystein Gomo
A1 Estomih Mduma
A1 Joar Eilevstjønn
A1 Ketil Størdal
YR 2017
UL http://fn.bmj.com/content/102/3/F208.abstract
AB 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.