Zhou Ming, Xi Xiaohong, Zhao Pu, Wang Silu, Tao Fangfang, Gu Xiaoying, Cheung Po-Yin, Liu Jiang-Qin
Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Pediatrics, Stollery Philip C. Etches NICU at Royal Alexandra Hospital, University of Alberta, Edmonton, Canada.
Resusc Plus. 2024 Dec 31;21:100860. doi: 10.1016/j.resplu.2024.100860. eCollection 2025 Jan.
Effective ventilation is the core of neonatal resuscitation (NR). T-piece resuscitators (TPR) and self-inflating bags (SIB) are the two most widely utilized resuscitation devices. Nevertheless, limited information is available regarding the respiratory metrics during NR with these devices.
This study aimed to evaluate the respiratory metrics at different ventilatory rates (VR) using a TPR or SIB during NR training.
An observational, simulation study was conducted during a NR training course. The participants were instructed to perform positive pressure ventilation at predetermined pressures and varying rates using TPR and SIB. They were subsequently grouped into three categories based on their actual VR: 20-40 breaths per minute (bpm) (SlowVR), 40-60 bpm (StdVR), and 60-80 bpm (FastVR). Respiratory metrics were recorded and analyzed using a neonatal active lung model (NALM).
Of the 71 participants in the training course, data from 66 were validated by analyzing 198 ventilations. In general, the participants manipulated the TPR slightly slower than the SIB. Notably, the positive end-expiratory pressure (PEEP) detected via TPR in the NALM was substantially higher, whereas the tidal volume (Tv) and minute volume (MV) with TPR were significantly smaller than those with SIB (p < 0.05). A significant decrease in the peak alveolar pressure (palva) was observed with faster TPR ventilation (p < 0.001), whereas no such reduction was observed with SIB (p = 0.103). Additionally, faster VR correlated positively with higher PEEP levels for both TPR (F = 7.543, p = 0.002) and SIB (F = 7.720, p = 0.002) and inversely with smaller Tv for both TPR (F = 19.239, p < 0.001) and SIB (F = 14.937, p < 0.001). However, no significant differences in MV were observed across the different VR for either TPR or SIB (both p > 0.05).
Faster VR were inversely associated with smaller Tv but increased PEEP in both devices. Despite the guidelines of NR, VR exceeding 60 bpm with TPR might sometimes be used, was associated with excessive PEEP in TPR, which may not be a safe in clinical practice. The effect of varying VR on MV was relatively minor for both TPR and SIB.
有效通气是新生儿复苏（NR）的核心。T形管复苏器（TPR）和自动充气式气囊（SIB）是两种使用最广泛的复苏设备。然而，关于使用这些设备进行新生儿复苏期间的呼吸指标信息有限。
本研究旨在评估在新生儿复苏培训期间使用TPR或SIB以不同通气率（VR）时的呼吸指标。
在一次新生儿复苏培训课程期间进行了一项观察性模拟研究。指导参与者使用TPR和SIB在预定压力和不同通气率下进行正压通气。随后根据他们的实际通气率将他们分为三类：每分钟20 - 40次呼吸（bpm）（慢通气率）、40 - 60 bpm（标准通气率）和60 - 80 bpm（快通气率）。使用新生儿动态肺模型（NALM）记录并分析呼吸指标。
在培训课程的71名参与者中，通过分析198次通气对66名参与者的数据进行了验证。总体而言，参与者操作TPR的速度略慢于SIB。值得注意的是，通过TPR在NALM中检测到的呼气末正压（PEEP）明显更高，而TPR的潮气量（Tv）和分钟通气量（MV）显著小于SIB（p < 0.05）。随着TPR通气速度加快，观察到肺泡峰压（palva）显著降低（p < 0.001），而SIB未观察到这种降低（p = 0.103）。此外，对于TPR（F = 7.543，p = ）和SIB（F = 7.720，p = 0.002），更快的通气率与更高的PEEP水平呈正相关，与更小的Tv呈负相关（TPR：F = 19.239，p < 0.001；SIB：F = 14.937，p < 0.001）。然而，对于TPR或SIB，在不同通气率下MV均未观察到显著差异（p均> 0.05）。
更快的通气率与更小的Tv呈负相关，但两种设备的PEEP均增加。尽管有新生儿复苏指南，但使用TPR时通气率超过60 bpm有时可能会导致TPR中PEEP过高，这在临床实践中可能不安全。通气率变化对TPR和SIB的MV影响相对较小。
