title: Manual neonatal ventilation training: a respiratory function  monitor helps to reduce peak inspiratory pressures and tidal  volumes during resuscitation.
abstract: BACKGROUND
  Neonatal resuscitation training is considered to be multifarious and includes manual ventilation as an essential competence for any health-care provider. Usually, ventilation is applied with self-inflating bags (SIBs). These devices have been shown to produce highly variable, operator-dependent peak inspiratory pressures (PIPs) and tidal volumes (V(T)). Excessive PIP and V(T) contribute to lung injury. We studied a simple tool to improve resuscitation skills.
  
  
  OBJECTIVE
  The objectives of this study were to train healthcare providers to avoid excessive PIP and V(T) by visualizing these values by using a respiratory function monitor (RFM) and to study the sustainability of such a training.
  
  
  METHODS
  Previously untrained medical professionals were educated and trained to ventilate a neonatal preterm manikin. PIP and V(T) were measured with an RFM. Graphical representations of the measurements were displayed during training, but the RFM was blinded during subsequent recordings. Participants were reassessed directly after training and 1 month later.
  
  
  RESULTS
  In total, 37 participants were trained and assessed three times during the study. Median PIPs (range) were 32.3 (4.1 – 44) cm H(2)O before training, 17.8 (9.6 – 23.6) cm H(2)O directly after training (P < 0.05), and 18.7 (7.5 – 41.6) cm H(2)O 1 month later, and the values remained low, compared with before training (P < 0.05). Median V(T)s were 6.7 (4.2 – 44) mL before training, 3.5 (1.8 – 7.3) mL directly after training (P < 0.05), and 4.1 (1.9 – 9.7 mL) 1 month after training (P < 0.05).
  
  
  CONCLUSIONS
  Using a SIB, untrained staff produced excessive PIP and V(T). Training with a simple RFM significantly reduced the occurrence of excessive PIP and V(T). The effect was sustained for at least 1 month.
authors.affiliation: Klinik für Neonatologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Kelm
authors.forename: Simone K
authors.initials: SK
authors.lastname: Dold
authors.forename: Julia
authors.initials: J
authors.lastname: Hartung
authors.forename: Jan
authors.initials: J
authors.lastname: Breckwoldt
authors.forename: Gerd
authors.initials: G
authors.lastname: Schmalisch
authors.forename: Charles C
authors.initials: CC
authors.lastname: Roehr
mesh_terms: D000328:Adult; D006801:Humans; D007231:Infant, Newborn; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*; D012129:Respiratory Function Tests / Q000295:instrumentation; D012151:Resuscitation / Q000193:education* / Q000295:instrumentation / Q000379:methods; D013990:Tidal Volume