title: An evaluation of peak inspiratory pressure, tidal volume, and ventilatory frequency during ventilation with a neonatal self-inflating bag resuscitator.
abstract: BACKGROUND
  Although the self-inflating bag is widely used in the hospital setting, variability of delivered ventilatory parameters is usually high, which might result in both hypoventilation and lung injury. The aims of this study were to assess possible sources of the high variability  and to evaluate the adequacy of obtained values in relation to the recommended values for neonatal resuscitation.
  
  
  METHODS
  This was an experimental study in which 172 health professionals (physicians, resident physicians, physiotherapists, nurses, and nursing technicians) who work with neonatal  intensive care manually ventilated a test lung (adjusted to simulate the lungs of an intubated term newborn) with a self-inflating bag in 5 different handling techniques, using 10, 5, 4, 3, and 2 fingers. Delivered values of peak inspiratory pressure (PIP), tidal volume (V(T)), and  ventilatory frequency (f) were compared, taking into account the different handling modalities and professions by analysis of variance for repeated measures. Chi-square, the Friedman test and the Fisher exact tests were performed to compare the delivered and standard values.
  
  
  RESULTS
  PIP and  V(T) were significantly affected by the handling technique, with higher values for a greater number of fingers used for ventilation. Profession also influenced V(T) and f significantly: physiotherapists tended to deliver higher volumes and lower rates. Nevertheless, we observed  high variability of all studied ventilatory parameters and overall inadequacy of obtained values. Most volunteers delivered excessive pressures and volumes at insufficient ventilatory frequency.
  
  
  CONCLUSIONS
  Delivered values seem to depend on operators' individual and professional differences,  as well as on the number of fingers used to compress the bag. However, from the clinical point of view, it is important to point out the high occurrence of inadequate delivered values, regardless of handling technique and profession.
authors: Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. bassanimariana@hotmail.com
authors: Mariana Almada
authors: MA
authors: Bassani
authors: Francisco Mezzacappa
authors: FM
authors: Filho
authors: Maria Regina
authors: MR
authors: de Carvalho Coppo
authors: Sérgio Tadeu
authors: ST
authors: Martins Marba
mesh_terms: D003422:Critical Care; D004867:Equipment Design; D006801:Humans; D007231:Infant, Newborn; D008422:Materials Testing; D012121:Respiration, Artificial; D013990:Tidal Volume