Responding to compliance changes in a lung model during manual ventilation: perhaps volume, rather than pressure, should be displayed.
OBJECTIVE
The standard technique for positive-pressure ventilation is to regulate the breath size by varying the pressure applied to the bag. Investigators have argued that consistency of peak inspiratory pressure is important. However, research shows that excessive tidal volume delivered with excessive pressure injures preterm lungs, which suggests that inspiratory pressure should be varied during times of changing compliance, such as resuscitation of newborns or treatment after surfactant delivery.


METHODS
We modified a computerized lung model (ASL5000 [IngMar Medical, Pittsburgh, PA]) to simulate the functional residual capacity of a 3-kg neonate with apnea and programmed it to change compliance during ventilation. Forty-five professionals were blinded to randomized compliance changes while using a flow-inflating bag, a self-inflating bag, and a T-piece resuscitator. We instructed subjects to maintain a constant inflation volume, first while blinded to delivered volume and then with volume displayed, with all 3 devices.


RESULTS
Subjects adapted to compliance changes by adjusting inflation pressure more effectively when delivered volume was displayed. When only pressure was displayed, sensing of compliance changes occurred only with the self-inflating bag. When volume was displayed, adjustments to compliance changes occurred with all 3 devices, although the self-inflating bag was superior.


CONCLUSIONS
In this lung model, volume display permitted far better detection of compliance changes compared with display of only pressure. Devices for administration of positive-pressure ventilation should display volume rather than pressure.
Kattwinkel
John
J
University of Virginia, Department of Pediatrics, Box 800386, Charlottesville, VA 22908, USA. jk3f@virginia.edu
Stewart
Corrine
C
Walsh
Brian
B
Gurka
Matthew
M
Paget-Brown
Alix
A
D001049:Apnea / Q000503:physiopathology* / Q000628:therapy; D003198:Computer Simulation; D005260:Female; D005652:Functional Residual Capacity / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D001239:Inhalation / Q000502:physiology*; D007363:Intensive Care Units, Neonatal; D008170:Lung Compliance / Q000502:physiology*; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology* / Q000628:therapy; D012151:Resuscitation / Q000379:methods*; D012984:Software; D013990:Tidal Volume