title: Neonatal resuscitation in resource-limited settings: titrating oxygen delivery without an oxygen blender.
abstract: OBJECTIVE
  To test whether 4 commonly used self-inflating bags with a reservoir in situ can reliably deliver different oxygen concentrations (21%-100%) using a portable oxygen cylinder with flows of ≤5 L/min.
  
  
  METHODS
  Four self-inflating bags (from Laerdal, Ambu, Parker Healthcare, and Mayo Healthcare) were tested to provide positive pressure ventilation to a manikin at 60 inflations/min by 4 operators. Oxygen delivery was measured for 2 minutes, combining oxygen flows (0.25, 0.5, 1, 5 L/min) and peak inspiratory pressures (PIPs 20-25, 35-40 cmH2O).
  
  
  RESULTS
  Combinations (n=128) were performed twice. Oxygen delivery depended upon device, oxygen flow, and PIP. All self-inflating bags delivered mean oxygen concentrations of <40% with 0.25 L/min, regardless of PIP. Three self-inflating bags delivered ≤40% with flow 0.5 L/min at PIP 35-40 cmH2O, whereas all delivered >40% at PIP 20-25 cmH2O. With 1 L/min, 3 self-inflating bags delivered 40%-60% at PIP 35-40 cmH2O and all delivered >60% at PIP 20-25 cmH2O. With 5 L/min, all self-inflating bags delivered close to or 100%, regardless of PIP. Differences in oxygen delivery between self-inflating bags were statistically significant (P<.001) even when differences were not clinically important.
  
  
  CONCLUSIONS
  Self-inflating bags with a reservoir in situ can deliver a variety of oxygen concentrations without a blender, from <40% with 0.25 L/min oxygen flow to 100% with 5 L/min. The adjustment of oxygen flow may be a useful method of titrating oxygen in settings where air-oxygen blenders are unavailable.
authors.affiliation: Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; Hospital Sant Joan de Deu, Barcelona, Spain; The University of Melbourne, Victoria, Australia. Electronic address: marta.thiolluch@thewomens.org.au.
authors.forename: Marta
authors.initials: M
authors.lastname: Thio
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Liselotte
authors.initials: L
authors.lastname: van Kempen
authors.affiliation: Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Rafferty
authors.affiliation: Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Risha
authors.initials: R
authors.lastname: Bhatia
authors.affiliation: Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; The University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Dawson
authors.affiliation: Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; The University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
mesh_terms: D001315:Australia; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D004867:Equipment Design; D006295:Health Resources; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007327:Insufflation / Q000295:instrumentation*; D008348:Manikins; D010100:Oxygen / Q000008:administration & dosage*; D011175:Positive-Pressure Respiration / Q000295:instrumentation*
chemical_list: D010100:Oxygen