Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California San Diego Medical Center and School of Medicine, San Diego, CA 92103-8774, USA.
J Perinatol. 2010 Oct;30 Suppl:S57-66. doi: 10.1038/jp.2010.115.
In an effort to determine the actual conduct of neonatal resuscitation and the errors that may be occurring during this process, we developed a method of video recording neonatal resuscitations as an ongoing quality assurance project. We initiated video recordings of resuscitations using simple video recorders attached to an overhead warmer and reviewed the resultant tapes during biweekly quality improvement meetings. We also added the continuous recording of analog information such as heart rate, oximeter values, fraction of inspired oxygen and airway pressure. We subsequently developed a checklist that includes a preresuscitation briefing and a postresuscitation debriefing, all of which are reviewed at the same time as the video recording. We have examined the use of oxygen in the very preterm infant, the effectiveness of bag and mask ventilation, including the detection of airway obstruction during such ventilation, intubation in the delivery area and environment. In addition, we have trained our teams and leaders using Crew Resource Management and focused on improved communication. The availability of a dedicated room for resuscitation allows an increased ambient environment and the ability to provide a user-friendly setting similar to the neonatal intensive care unit to optimize performance. There are numerous opportunities for improving team and leader performance and outcomes following neonatal resuscitation. Further prospective studies are required to evaluate specific interventions.
为了确定新生儿复苏的实际操作以及在此过程中可能出现的错误，我们开发了一种视频记录新生儿复苏的方法，作为持续质量保证项目。我们使用简单的摄像机将摄像机安装在头顶保温器上，对复苏过程进行录像，并在两周一次的质量改进会议上查看录像带。我们还增加了模拟信息（如心率、血氧计值、吸入氧分数和气道压力）的连续记录。随后，我们制定了一份检查表，其中包括复苏前简报和复苏后讨论，所有这些都与视频记录同时进行审查。我们已经研究了极低出生体重儿使用氧气的情况、气囊面罩通气的效果，包括在通气过程中检测气道阻塞、在分娩区和环境中进行插管的情况。此外，我们还使用机组资源管理对团队和领导者进行了培训，并注重改善沟通。专门的复苏室可提供更好的环境，并能够设置类似于新生儿重症监护病房的用户友好环境，以优化复苏效果。有许多机会可以改善团队和领导者的表现和新生儿复苏的结果。需要进一步进行前瞻性研究，以评估具体的干预措施。
