Szyld Edgardo G, Aguilar Adriana M, Musante Gabriel A, Vain Néstor E, Guerrero Miriam N, Serra María Elina, Prudent Luis M, Carlo Waldemar A
Fundación para la salud Materno Infantil, Buenos Aires, Argentina.
Arch Argent Pediatr. 2012 Apr;110(2):106-12. doi: 10.5546/aap.2012.106.
Although the provision of effective assisted ventilation is the most effective intervention in delivery room resuscitation of depressed newborn infants, there is still limited evidence about which is the optimal device to deliver positive pressure ventilation (PPV).
To compare the accuracy of pressures and ventilation rate (VR) delivered to a neonatal simulator with three devices: 240 ml and 450 ml self-infating bags (SIB) and a T-piece resuscitator, and to evaluate the variability in terms of providers' experience.
76 health care providers divided in two groups according to experience were asked to provide positive pressure ventilation to a neonatal simulator through a facial mask or an endotracheal tube with three ventilating devices: a T-piece resuscitator, a 240 ml and a 450 ml self-infating bags. Participants used each combination of device and interface randomly on 2 consecutive occasions. Mean and maximum PIP and respiratory rate were recorded. Statistical analyses were performed using two-factor analysis of variance for repeated measures.
SIB 240 and 450 were similar in the mean target peak inspiratory pressure (PIP) but both were significantly different (p < 0.001) from T-piece, although all values were close to the target. Mean VR was over the target for all the devices (p < 0.001). The highest difference found was 7 ± 1.7 breaths/minute with the 240 ml bag when compared with the T-piece using a mask. Experienced operators were closer than novice operators to target VR, regardless of the device or interface.
The accuracy for the devices was comparable in the variables measured regardless operator´s experience. Overall, the T-piece provided lower PIP while both SIB, higher than the target. The VR was over the target for all the devices. Both SIB and novice participants were associated with higher VR. The intraoperator consistency was comparable in the variables measured with all devices.
尽管提供有效的辅助通气是对窒息新生儿进行产房复苏最有效的干预措施，但关于哪种是进行正压通气（PPV）的最佳设备，证据仍然有限。
比较使用三种设备向新生儿模拟器输送的压力和通气率（VR）的准确性：240毫升和450毫升自动充气式气囊（SIB）以及T形管复苏器，并评估不同经验水平的操作者之间的差异。
76名医疗保健提供者根据经验分为两组，要求他们通过面罩或气管内导管，使用三种通气设备（T形管复苏器、240毫升和450毫升自动充气式气囊）对新生儿模拟器进行正压通气。参与者在连续2次操作中随机使用每种设备和接口的组合。记录平均和最大吸气峰压（PIP）以及呼吸频率。采用重复测量的双因素方差分析进行统计分析。
240毫升和450毫升的自动充气式气囊在平均目标吸气峰压（PIP）方面相似，但与T形管复苏器相比均有显著差异（p < 0.001），尽管所有数值都接近目标值。所有设备的平均通气率均超过目标值（p < 0.001）。与使用面罩的T形管复苏器相比，使用240毫升气囊时发现的最大差异为7 ± 1.7次/分钟。无论使用何种设备或接口，经验丰富的操作者比新手操作者更接近目标通气率。
无论操作者经验如何，在所测量的变量中，各设备的准确性相当。总体而言，T形管复苏器提供的吸气峰压较低，而两种自动充气式气囊提供的吸气峰压均高于目标值。所有设备的通气率均超过目标值。自动充气式气囊和新手参与者的通气率都较高。在所有设备测量的变量中，操作者内部的一致性相当。
