Castera Mark, Gray Megan M, Gest Carri, Motz Patrick, Sawyer Taylor, Umoren Rachel
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA.
Telemed Rep. 2022 Mar 7;3(1):55-61. doi: 10.1089/tmr.2021.0049. eCollection 2022.
Positive pressure ventilation (PPV) is a critical skill for neonatal resuscitation. We hypothesized that telecoaching would improve PPV performance in neonatal providers during simulated neonatal resuscitations.
Level IV neonatal intensive care unit (NICU).
This prospective crossover study included 14 experienced NICU nurses and respiratory therapists who performed PPV on a mannequin that recorded parameters of ventilation efficiency. Participants were randomized to practice independently (control) or with live feedback from a remote facilitator through audiovisual connection (intervention) and then switched to the opposite group. Participants' mask leak percentage, ventilation rates, and pressure delivery were analyzed.
The primary outcome of mask leak percentage was significantly increased in the telecoaching group (19% [interquartile range {IQR} 14-59.25] vs. 100% [IQR 88-100] leak, = 0.0001). The secondary outcome of peak inspiratory pressure (PIP) delivery was also increased (median 27.6 [IQR 23.5-34.7] vs. 23.3 [IQR 19.1-32.8] cmHO, < 0.001). Differences in ventilation rates were not statistically significant (55 vs. 58 breaths/min, = 0.51).
Participants demonstrated better PPV performance during telecoaching with less mask leak. The intervention group also had higher measured peak inspiratory pressures. Telecoaching may be a feasible method to provide real-time feedback to health care providers during simulated neonatal resuscitations.
Neonatal providers who receive telecoaching during simulated resuscitations will perform PPV more effectively than those who do not receive telecoaching.
正压通气（PPV）是新生儿复苏的一项关键技能。我们假设远程指导能在模拟新生儿复苏过程中提高新生儿医护人员的PPV操作水平。
四级新生儿重症监护病房（NICU）。
这项前瞻性交叉研究纳入了14名经验丰富的NICU护士和呼吸治疗师，他们在一个能记录通气效率参数的人体模型上进行PPV操作。参与者被随机分为独立练习组（对照组）或通过视听连接接受远程指导者实时反馈的组（干预组），然后两组互换。分析了参与者的面罩漏气百分比、通气频率和压力输送情况。
远程指导组的主要结局指标面罩漏气百分比显著增加（漏气率为19%[四分位间距{IQR}为14 - 59.25]，而对照组为100%[IQR为88 - 100]，P = 0.0001）。次要结局指标吸气峰压（PIP）输送也有所增加（中位数为27.6[IQR为23.5 - 34.7]cmH₂O，而对照组为23.3[IQR为19.1 - 32.8]cmH₂O，P < 0.001）。通气频率的差异无统计学意义（分别为55次/分钟和58次/分钟，P = 0.51）。
参与者在远程指导期间表现出更好的PPV操作水平，面罩漏气更少。干预组的吸气峰压测量值也更高。远程指导可能是在模拟新生儿复苏期间为医护人员提供实时反馈的一种可行方法。
在模拟复苏期间接受远程指导的新生儿医护人员进行PPV操作比未接受远程指导的人员更有效。
