title: Variability in the assessment of 'adequate' chest excursion during simulated neonatal resuscitation.
abstract: BACKGROUND
  International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing 'adequate' chest excursion lacks objectivity.
  
  
  OBJECTIVE
  It was the aim of this study to test the accuracy in the assessment of 'adequate' chest excursion by measuring intra- and inter-observer variability of participants during simulated neonatal resuscitation.
  
  
  METHODS
  Thirty-seven staff members (8 neonatologists, 8 registrars, 21 nurses) of the Neonatal Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands, ventilated 2 different intubated, leak-free manikins at 2 attempts, each with a different compliance. Blinded to the manometer, participants could change the peak inflation pressure until chest movement was adequate according to their perception. Inflating pressures were recorded.
  
  
  RESULTS
  According to the participants, a median (interquartile range) pressure of 18 cm H2O (16-22) at the first and 18 cm H2O (16-25) at the second attempt were needed to reach adequate chest excursion in the Laerdal manikin. The HAL manikin needed 26 cm H2O (19-31) and 24 cm H2O (22-33), respectively. The inter-observer coefficient of variance was 30% with the Laerdal manikin at both attempts, and 35 and 40% with the HAL manikin, respectively. The intra-observer coefficient of variance was 15% (8-23) with the Laerdal and 13% (9-20) with the HAL manikin. In both manikins and attempts, no significant differences in pressures and variances of pressures between the 3 groups were found.
  
  
  CONCLUSIONS
  'Adequate' chest excursion is a subjective parameter for guidance of appropriate ventilation during neonatal resuscitation.
authors.affiliation: Neonatal Research Unit and Institute for Health Research, University Hospital La Fe, Valencia, Spain. mabrumon@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Brugada
authors.forename: K
authors.initials: K
authors.lastname: Schilleman
authors.forename: R S
authors.initials: RS
authors.lastname: Witlox
authors.forename: F J
authors.initials: FJ
authors.lastname: Walther
authors.forename: M
authors.initials: M
authors.lastname: Vento
authors.forename: A B
authors.initials: AB
authors.lastname: Te Pas
mesh_terms: D035641:Chest Wall Oscillation / Q000379:methods / Q000592:standards; D002983:Clinical Competence; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D008348:Manikins; D008505:Medical Staff, Hospital; D009359:Neonatology; D015588:Observer Variation; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D013909:Thorax; D012122:Ventilators, Mechanical; D000078329:Workforce