title: Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision.
abstract: BACKGROUND
  Excessive peak inspiratory pressures (PIP) and high tidal volumes (Vt) during manual ventilation can be detrimental to the neonatal lung. We compared the influence of different manual ventilation devices and individual professional experience on the extent of applied Vt and PIP in simulated neonatal resuscitation.
  
  
  METHODS
  One hundred and twenty medical professionals were studied. An intubated mannequin (equivalent to 1.0 kg neonate) was ventilated using two different devices: a self-inflating bag and a T-piece resuscitator. Target value was a PIP of 20 cm H(2)O. Applied PIP and the resulting Vt were recorded continuously using a respiratory function monitor (CO(2)SMO(+), Novametrix, USA).
  
  
  RESULTS
  Vt and PIP provision was significantly higher in SI-bags, compared to T-piece devices: median (interquartile range) PIP 25.6 (18.2) cm H(2)O vs 19.7 (3.2) cm H(2)O (p<0.0005), and Vt 5.1(3.2) ml vs Vt 3.6 (0.8) ml (p<0.0005) respectively. The intersubject variability of Vt and PIP provision was distinctly higher in SI-bags, compared to T-piece devices. Professional experience had no significant impact on the level and the variability of Vt or PIP provided.
  
  
  CONCLUSIONS
  Use of T-piece devices guarantees reliable and constant Vt and PIP provision, irrespective of individual, operator dependent variables. Methods to measure and to avoid excessive tidal volumes in neonatal resuscitation need to be developed.
authors.affiliation: Clinic of Neonatology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. christoph.roehr@charite.de
authors.forename: Charles C
authors.initials: CC
authors.lastname: Roehr
authors.forename: Marcus
authors.initials: M
authors.lastname: Kelm
authors.forename: Hendrik S
authors.initials: HS
authors.lastname: Fischer
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
authors.forename: Gerd
authors.initials: G
authors.lastname: Schmalisch
authors.forename: Hans
authors.initials: H
authors.lastname: Proquitté
mesh_terms: D018592:Cross-Over Studies; D006801:Humans; D007231:Infant, Newborn; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation*; D012151:Resuscitation / Q000295:instrumentation*; D013990:Tidal Volume