Sawyer T, Motz P, Schooley N, Umoren R
Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
J Neonatal Perinatal Med. 2019;12(3):243-248. doi: 10.3233/NPM-1618119.
Positive pressure ventilation (PPV) is the most important procedure during neonatal resuscitation. Providing effective PPV seems easy. However, performing the procedure correctly is extremely challenging. Airway obstruction and face mask large leaks are common. It is estimated that two-thirds of continued neonatal respiratory depression after the time of birth is caused by ineffective or improperly provided PPV. Finding methods to improve PPV performance are critically needed. Performance coaching is a simple and easy method of improving performing in procedural skills, and has been used previously to optimize compression technique. We performed the simulation-based pilot study to evaluate the impact of PPV coaching during neonatal bag-mask ventilation.
Randomized cross-over study of nurses performing PPV on a SMART Newborn Resuscitation Training System with, and without, coaching. The PPV coach provided real-time feedback on chest rise, mask hold, and ventilation rate. The SMART system captured data on peak inspiratory pressure (PIP), tidal volume (Vt), mask leak, and ventilation rate. Data were analyzed by a blinded reviewer.
PPV coaching resulted in more appropriate PIPs (34 cmH2O, IQR 32-38 vs. 36 cmH2O, IQR 28-37; P < 0.001), lower Vt (4.7 ml/kg, IQR 4-8 vs. 5.5 ml/kg, IQR 4-13; P < 0.001), and less mask leak (39% leak, IQR 21-70 vs. 45%, IQR 22-98; P = 0.005). There was no difference in respiratory rate (P = 0.93).
Coaching improved PPV performance in this simulation-based pilot study. Further research on PPV coaching during neonatal resuscitation is warranted.
正压通气（PPV）是新生儿复苏过程中最重要的操作。提供有效的PPV看似容易。然而，正确实施该操作极具挑战性。气道梗阻和面罩大量漏气很常见。据估计，出生后持续的新生儿呼吸抑制中有三分之二是由无效或不当的PPV所致。迫切需要找到改善PPV操作的方法。操作指导是一种简单易行的提高操作技能的方法，此前已用于优化按压技术。我们进行了一项基于模拟的初步研究，以评估新生儿面罩通气时PPV指导的影响。
对在智能新生儿复苏训练系统上进行PPV操作的护士进行随机交叉研究，分为有指导和无指导两组。PPV指导人员就胸廓起伏、面罩固定和通气频率提供实时反馈。智能系统记录吸气峰压（PIP）、潮气量（Vt）、面罩漏气和通气频率数据。由一位不知情的评审人员进行数据分析。
PPV指导使PIP更合适（34 cmH₂O，四分位间距32 - 38 vs. 36 cmH₂O，四分位间距28 - 37；P＜0.001），Vt更低（4.7 ml/kg，四分位间距4 - 8 vs. 5.5 ml/kg，四分位间距4 - 13；P＜0.001），面罩漏气更少（漏气39%，四分位间距21 - 70 vs. 45%，四分位间距22 - 98；P = 0.005）。呼吸频率无差异（P = 0.93）。
在这项基于模拟的初步研究中，指导改善了PPV操作。有必要对新生儿复苏期间的PPV指导进行进一步研究。
