title: How doctors learn and perform sustained inflations with a self-inflating bag: a manikin study with a newborn lung simulator.
abstract: OBJECTIVE
  Sustained inflations during initial resuscitation may help a depressed infant make a more efficient transition to air-filled lungs. This study examined whether doctors could perform sustained inflations with a self-inflating bag in high and low compliance settings and with an open or blocked pressure-relief valve.
  
  
  METHODS
  We asked 43 doctors to carry out sustained inflations for more than 5-sec in a manikin connected to a newborn lung simulator with randomised compliance settings. Tidal volume, inflation time, peak and mean inflating pressure were measured, and 34 were retested 3 months later.
  
  
  RESULTS
  The majority of the doctors - 72% in the initial study and 62% in the retest - managed sustained inflations within three ventilation attempts, irrespective of lung compliance setting and years of work experience. Using a blocked pressure-relief valve produced higher tidal volume (27.8 versus 22.6 mL, p < 0.001), inflation time (8.9 versus 8.1 sec, p = 0.025), peak inflating pressure (34.0 versus 28.0 cmH2O; p = 0.012) and mean inflating pressure (28.1 versus 22.8 cmH2O; p < 0.001).
  
  
  CONCLUSIONS
  The majority of doctors could deliver sustained inflation with a self-inflating bag in a newborn lung simulator for more than 5-sec. Using a blocked pressure-relief valve resulted in higher inflation time, tidal volume and inflation pressure.
authors.affiliation: Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; Akershus Faculty Division, University of Oslo, Lørenskog, Norway.
authors.forename: Anne Marthe
authors.initials: AM
authors.lastname: Boldingh
authors.forename: Anne L
authors.initials: AL
authors.lastname: Solevåg
authors.forename: Jūratė Šaltytė
authors.initials: JŠ
authors.lastname: Benth
authors.forename: Claus
authors.initials: C
authors.lastname: Klingenberg
authors.forename: Britt
authors.initials: B
authors.lastname: Nakstad
mesh_terms: D000328:Adult; D006801:Humans; D007231:Infant, Newborn; D007327:Insufflation / Q000379:methods; D008168:Lung; D008348:Manikins; D012151:Resuscitation / Q000193:education*; D000066908:Simulation Training
keywords: Infant; Newborn lung simulator; Newborn manikin study; Self-inflating bag; Sustained inflation