H L Ersdal1, J Eilevstjonn2, J Perlman3, Ø Gomo4, R Moshiro5, P Mdoe6, H Kidanto7, S B Hooper8, J E Linde9. 1. Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway; Faculty of Health Sciences, University of Stavanger, Norway. Electronic address: hege.ersdal@safer.net. 2. Department of Research, Laerdal Medical/Laerdal Global Health, Tanke Svilands gate 30, 4002 Stavanger, Norway. Electronic address: joar.eilevstjonn@laerdal.com. 3. Department of Pediatrics, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA. Electronic address: jmp2007@med.cornell.edu. 4. Department of Research, Laerdal Medical/Laerdal Global Health, Tanke Svilands gate 30, 4002 Stavanger, Norway. Electronic address: oystein.gomo@laerdal.com. 5. Department of Research, Haydom Lutheran Hospital, Tanzania; Department of Paediatrics and Child Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. Electronic address: moshiror@gmail.com. 6. Department of Research, Haydom Lutheran Hospital, Tanzania. Electronic address: pfmdoe@gmail.com. 7. Medical College, Aga Khan University, P.O Box 38129, Dar es Salaam, Tanzania. Electronic address: hussein.kidanto@aku.edu. 8. The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, 27-31 Wright Street, Clayton, VIC 3168, Australia. Electronic address: stuart.hooper@monash.edu. 9. Department of Paediatrics, Stavanger University Hospital, POB 8100, 4068 Stavanger, Norway. Electronic address: joga@sus.no.
Abstract
AIM OF THE STUDY: Establishing functional residual capacity (FRC) during positive pressure ventilation (PPV) of apnoeic neonates is critical for survival. This may be difficult due to liquid-filled airways contributing to low lung compliance. The objectives were to describe initial PPV, changes in lung compliance and establishment of FRC in near-term/term neonates ≥36 weeks gestation at birth. METHODS: Observational study of all neonatal resuscitations between 01.07.13 and 30.06.18 in a Tanzanian referral hospital. Perinatal events and characteristics were observed and recorded by trained research assistants. PPV were performed using self-inflating bag-masks without positive end-expiratory pressure (PEEP). Ventilation signals (pressure/flow), expired CO2 (ECO2) and heart rate were recorded by resuscitation monitors. RESULTS: 19,587 neonates were born, 1451 received PPV, of these 821 of median (p25, p75) birthweight 3180 (2844, 3500) grams and gestation 38 (37, 40) weeks had ≥20 ventilations and complete datasets. There was a significant increase in expired volume (from 3.3 to 6.0 ml/kg), ECO2 (0.3-2.4%), lung compliance (0.13-0.19 ml/kg/mbar) and heart rate (109-138 beats/min) over the first 20 PPVs. Inflation volume, time, and peak inflation pressure (PIP) were stable around 12-13 ml/kg, 0.45 s, and 36 mbar, respectively. CONCLUSIONS: The combination of increasing expired volumes, ECO2, and heart rate with decreasing inflation/expired volume ratios and constant PIP, suggests establishment of FRC during the first 20 PPVs in near-term/term neonates using a self-inflating bag-mask without PEEP, the most common device worldwide for ventilating non-breathing neonates. Initial lung compliance is low, and with short inflation times, higher than recommended PIP seem necessary to deliver adequate tidal volumes.
AIM OF THE STUDY: Establishing functional residual capacity (FRC) during positive pressure ventilation (PPV) of apnoeic neonates is critical for survival. This may be difficult due to liquid-filled airways contributing to low lung compliance. The objectives were to describe initial PPV, changes in lung compliance and establishment of FRC in near-term/term neonates ≥36 weeks gestation at birth. METHODS: Observational study of all neonatal resuscitations between 01.07.13 and 30.06.18 in a Tanzanian referral hospital. Perinatal events and characteristics were observed and recorded by trained research assistants. PPV were performed using self-inflating bag-masks without positive end-expiratory pressure (PEEP). Ventilation signals (pressure/flow), expired CO2 (ECO2) and heart rate were recorded by resuscitation monitors. RESULTS: 19,587 neonates were born, 1451 received PPV, of these 821 of median (p25, p75) birthweight 3180 (2844, 3500) grams and gestation 38 (37, 40) weeks had ≥20 ventilations and complete datasets. There was a significant increase in expired volume (from 3.3 to 6.0 ml/kg), ECO2 (0.3-2.4%), lung compliance (0.13-0.19 ml/kg/mbar) and heart rate (109-138 beats/min) over the first 20 PPVs. Inflation volume, time, and peak inflation pressure (PIP) were stable around 12-13 ml/kg, 0.45 s, and 36 mbar, respectively. CONCLUSIONS: The combination of increasing expired volumes, ECO2, and heart rate with decreasing inflation/expired volume ratios and constant PIP, suggests establishment of FRC during the first 20 PPVs in near-term/term neonates using a self-inflating bag-mask without PEEP, the most common device worldwide for ventilating non-breathing neonates. Initial lung compliance is low, and with short inflation times, higher than recommended PIP seem necessary to deliver adequate tidal volumes.
Authors: Janine Thomann; Christoph M Rüegger; Vincent D Gaertner; Eoin O'Currain; Omar F Kamlin; Peter G Davis; Laila Springer Journal: BMC Pediatr Date: 2022-09-13 Impact factor: 2.567
Authors: John Madar; Charles C Roehr; Sean Ainsworth; Hege Ersda; Colin Morley; Mario Rüdiger; Christiane Skåre; Tomasz Szczapa; Arjan Te Pas; Daniele Trevisanuto; Berndt Urlesberger; Dominic Wilkinson; Jonathan P Wyllie Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.892