Use of Respiratory Function Monitors during Simulated Neonatal Resuscitation

Abstract

We describe how a Respiratory Function Monitor (RFM) can aid during simulation-based manikin training. We demonstrate how a RFM can provide quantitative and qualitative assessment of the trainee's resuscitation technique. A RFM can assist i) to identify correct mask hold and positioning techniques; ii) to assess the delivered airway pressures and adjust the inflating pressures to deliver the appropriate tidal volume.

Zusammenfassung

Anhand von Beispielen demonstrieren wir, wie ein Atmungsfunktionsmonitor (RFM) während des Trainings zur quantitativen und qualitativen Beurteilung des Auszubildenden verwendet werden kann. Ein RFM kann die optimale Maskenposition identifizieren und Rückkopplung über das vorhandene Maskenleck geben. Weiterhin kann der Beatmungsdruck gemessen und ggf. adaptiert werden, um ein adäquates Atemzugsvolumen zu verabreichen.

Key words

positive pressure ventilation - respiratory function monitor - neonatal resuscitation - tidal volume - face mask - leak - simulation-based manikin training

Schlüsselwörter

positive Druckbeatmung - Atemfunktionsmonitor - neonatale Reanimation - Tidalvolumen - Beatmungsmaske - Leck - Simulationstraining

References

• 1 Bennett S, Finer NN, Rich W. et al . A comparison of three neonatal resuscitation devices.  Resuscitation. 2005;  67 113-118
• 2 Bjorklund LJ, Ingimarsson J, Curstedt T. et al . Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs.  Pediatr Res. 1997;  42 348-355
• 3 Boehler T, Schaeff B, Hornberg I. et al . How nationally concordated measures for quality assurance in clinical care of term and preterm infants are put into practice in Baden-Württemberg.  Klin Padiatr. 2009;  221 256-265
• 4 Clark RH, Gerstmann DR, Jobe AH. et al . Lung injury in neonates: causes, strategies for prevention, and long-term consequences.  J Pediatr. 2001;  139 478-486
• 5 Gortner L. Structure of perinatal and neonatal care–impact for outcome data?.  Klin Padiatr. 2009;  221 217-218
• 6 Halamek LP. Teaching versus learning and the role of simulation-based training in pediatrics.  J Pediatr. 2007;  151 329-330
• 7 Halamek LP. The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation.  Semin Fetal Neonatal Med. 2008;  13 448-453
• 8 Hillman NH, Moss TJ, Kallapur SG. et al . Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep.  Am J Respir Crit Care Med. 2007 15;  176 575-581
• 9 Hoehn T, Hoppenz M. Neonatal and childhood mortality rates in Myanmar.  Klin Padiatr. 2009;  221 312-317
• 10 Iriondo M, Thio M, Buron E. et al . A survey of neonatal resuscitation in Spain: gaps between guidelines and practice.  Acta Paediatr. 2009;  98 786-791
• 11 Johnston ED, Stenson BJ. Am I getting chest wall movement?.  Arch Dis Child Fetal Neonatal Ed. 2010;  95 F391-F392
• 12 Kamlin CO, Dawson JA, O’Donnell CP. et al . Accuracy of pulse oximetry measurement of heart rate of newborn infants in the delivery room.  J Pediatr. 2008;  152 756-760
• 13 Kamlin CO, O’Donnell CP, Everest NJ. et al . Accuracy of clinical assessment of infant heart rate in the delivery room.  Resuscitation. 2006;  71 319-321
• 14 Kattwinkel J, Perlman JM, Aziz K. et al . Special Report–Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.  Pediatrics. 2010; 
• 15 Kattwinkel J, Stewart C, Walsh B. et al . Responding to compliance changes in a lung model during manual ventilation: perhaps volume, rather than pressure, should be displayed.  Pediatrics. 2009r;  123 e465-e470
• 16 Kelm M, Proquitte H, Schmalisch G. et al . Reliability of two common PEEP-generating devices used in neonatal resuscitation.  Klin Padiatr. 2009;  221 415-418
• 17 Kelm M, Roehr CC, Schmalisch G. et al . Schulung und praktisches Vorgehen am künstlichen Lungenmodell des Neugeborenen beeinflußt die Höhe des applizierten Spitzendruckes und des Tidalvolumens.  Z Geburtshilfe Neonatol. 2007;  211 (Suppl 1) 15
• 18 Leone TA, Rich W, Finer NN. A survey of delivery room resuscitation practices in the United States.  Pediatrics. 2006;  117 e164-e175
• 19 Manley BJ, Dawson JA, Kamlin CO. et al . Clinical assessment of extremely premature infants in the delivery room is a poor predictor of survival.  Pediatrics. 2010;  125 e559-e564
• 20 McHale S, Thomas M, Hayden E. et al . Variation in inspiratory time and tidal volume with T-piece neonatal resuscitator: association with operator experience and distraction.  Resuscitation. 2008;  79 230-233
• 21 Morley CJ, Dawson JA, Stewart MJ. et al . The effect of a PEEP valve on a Laerdal neonatal self-inflating resuscitation bag.  J Paediatr Child Health. 2010;  46 51-56
• 22 Newborn Life Support Subcommittee . Newborn Life Support – Resuscitation at Birth.  (2nd edition) 2006; 
• 23 O’Donnell CP, Davis PG, Lau R. et al . Neonatal resuscitation 2: an evaluation of manual ventilation devices and face masks.  Arch Dis Child Fetal Neonatal Ed. 2005;  90 F392-F396
• 24 O’Donnell CP, Davis PG, Lau R. et al . Neonatal resuscitation 3: manometer use in a model of face mask ventilation.  Arch Dis Child Fetal Neonatal Ed. 2005;  90 F397-F400
• 25 O’Donnell CP, Davis PG, Morley CJ. Positive pressure ventilation at neonatal resuscitation: review of equipment and international survey of practice.  Acta Paediatr. 2004;  93 583-588
• 26 O’Donnell CP, Davis PG, Morley CJ. Use of supplementary equipment for resuscitation of newborn infants at tertiary perinatal centres in Australia and New Zealand.  Acta Paediatr. 2005;  94 1261-1265
• 27 O’Donnell CP, Kamlin CO, Davis PG. et al . Clinical assessment of infant colour at delivery.  Arch Dis Child Fetal Neonatal Ed. 2007;  92 F465-F467
• 28 O’Donnell CP, Kamlin CO, Davis PG. et al . Interobserver variability of the 5-min Apgar score.  J Pediatr. 2006;  149 486-489
• 29 O’Donnell CP, Kamlin CO, Davis PG. et al . Neonatal resuscitation 1: a model to measure inspired and expired tidal volumes and assess leakage at the face mask.  Arch Dis Child Fetal Neonatal Ed. 2005;  90 F388-F391
• 30 O’Donnell CP, Stenson BJ. Respiratory strategies for preterm infants at birth.  Semin Fetal Neonatal Med. 2008;  13 401-409
• 31 Palme C, Nystrom B, Tunell R. An evaluation of the efficiency of face masks in the resuscitation of newborn infants.  Lancet. 1985;  1 207-210
• 32 Perlman JM, Wyllie J, Kattwinkel J. et al . Special Report–Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.  Pediatrics. 2010; 
• 33 Polglase GR, Hillman NH, Pillow JJ. et al . Positive end-expiratory pressure and tidal volume during initial ventilation of preterm lambs.  Pediatr Res. 2008;  64 517-522
• 34 Poulton DA, Schmölzer GM, Morley CJ. et al . Assessment of chest rise during mask ventilation of preterm infants in the delivery room.  Resuscitation. 2010;  82 175-179
• 35 Probyn ME, Hooper SB, Dargaville PA. et al . Effects of tidal volume and positive end-expiratory pressure during resuscitation of very premature lambs.  Acta Paediatr. 2005;  94 1764-1770
• 36 Probyn ME, Hooper SB, Dargaville PA. et al . Positive end expiratory pressure during resuscitation of premature lambs rapidly improves blood gases without adversely affecting arterial pressure.  Pediatr Res. 2004;  56 198-204
• 37 Rich WD, Leone T, Finer NN. Delivery room intervention: improving the outcome.  Clin Perinatol. 2010;  37 189-202
• 38 Richmond S, Wyllie J. European Resuscitation Council Guidelines for Resuscitation 2010 Section 7. Resuscitation of babies at birth.  Resuscitation. 2010;  81 1389-1399
• 39 Roehr CC, Grobe S, Rudiger M. et al . Delivery room management of very low birth weight infants in Germany, Austria and Switzerland–a comparison of protocols.  Eur J Med Res. 2010;  15 493-503
• 40 Roehr CC, Kelm M, Fischer HS. et al . Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision.  Resuscitation. 2010;  81 202-205
• 41 Schmalisch G, Fischer H, Roehr CC. et al . Comparison of different techniques to measure air leaks during CPAP treatment in neonates.  Med Eng Phys. 2009;  31 124-130
• 42 Schmölzer GM, Dawson JA, Kamlin COF. et al . Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room.  Arch Dis Child Fetal Neonatal Ed. 2010; 
• 43 Schmölzer GM, Kamlin OC, Dawson JA. et al . Respiratory monitoring of neonatal resuscitation.  Arch Dis Child Fetal Neonatal Ed. 2010;  95 F295-F303
• 44 Schmölzer GM, Kamlin OC, O’Donnell CP. et al . Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room.  Arch Dis Child Fetal Neonatal Ed. 2010;  95 F393-F397
• 45 Schmölzer GM, Morley CJ, Davis PG. Respiratory function monitoring to reduce mortality and morbidity in newborn infants receiving resuscitation.  Cochrane Database Syst Rev. 2010;  CD008437
• 46 Schmölzer GM, Olischar M, Raith W. et al . Review of equipment and survey of practice in Austria.  Monatsschr Kinderheilkd. 2010;  158 471-476
• 47 Schmölzer GM, Te Pas AB, Davis PG. et al . Reducing lung injury during neonatal resuscitation of preterm infants.  J Pediatr. 2008;  153 741-745
• 48 Siew ML, Te Pas AB, Wallace MJ. et al . Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth.  J Appl Physiol. 2009;  106 1487-1493
• 49 Singhal N, McMillan DD, Yee WH. et al . Evaluation of the effectiveness of the standardized neonatal resuscitation program.  J Perinatol. 2001;  21 388-392
• 50 Stenson BJ, Boyle DW, Szyld EG. Initial ventilation strategies during newborn resuscitation.  Clin Perinatol. 2006;  33 65-vii
• 51 Te Pas AB, Davis PG, Hooper SB. et al . From liquid to air: breathing after birth.  J Pediatr. 2008;  152 607-611
• 52 Te Pas AB, Davis PG, Kamlin CO. et al . Spontaneous breathing patterns of very preterm infants treated with continuous positive airway pressure at birth.  Pediatr Res. 2008;  64 281-285
• 53 Te Pas AB, Wong C, Kamlin CO. et al . Breathing patterns in preterm and term infants immediately after birth.  Pediatr Res. 2009;  65 352-356
• 54 Tracy MB, Klimek J, Shingde V. et al . Neopuff T-piece mask resuscitator: is mask leak related to watching the pressure dial?.  Acta Paediatr. 2010;  99 1314-1318
• 55 Trevisanuto D, Doglioni N, Ferrarese P. et al . Neonatal resuscitation of extremely low birthweight infants: a survey of practice in Italy.  Arch Dis Child Fetal Neonatal Ed. 2006;  91 F123-F124
• 56 Vento M, Aguar M, Leone TA. et al . Using intensive care technology in the delivery room: a new concept for the resuscitation of extremely preterm neonates.  Pediatrics. 2008;  122 1113-1116
• 57 Vilstrup CT, Bjorklund LJ, Werner O. et al . Lung volumes and pressure-volume relations of the respiratory system in small ventilated neonates with severe respiratory distress syndrome.  Pediatr Res. 1996;  39 127-133
• 58 Wood FE, Morley CJ, Dawson JA. et al . A respiratory function monitor improves mask ventilation.  Arch Dis Child Fetal Neonatal Ed. 2008;  93 F380-F381
• 59 Wood FE, Morley CJ, Dawson JA. et al . Assessing the effectiveness of two round neonatal resuscitation masks: study 1.  Arch Dis Child Fetal Neonatal Ed. 2008;  93 F235-F237
• 60 Wood FE, Morley CJ, Dawson JA. et al . Improved techniques reduce face mask leak during simulated neonatal resuscitation: study 2.  Arch Dis Child Fetal Neonatal Ed. 2008;  93 F230-F234
• 61 Wyllie J, Perlman JM, Kattwinkel J. et al . Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.  Resuscitation. 2010;  81 (Suppl 1) e260-e287
• 62 Yaeger KA, Halamek LP, Coyle M. et al . High-fidelity simulation-based training in neonatal nursing.  Adv Neonatal Care. 2004;  4 326-331

Correspondence