title: Newborn manikin study shows that physicians often fail to detect correct lung compliance when using a self-inflating bag.
abstract: OBJECTIVE
  Recognising changes in lung compliance can help clinicians to adjust initial inflations during resuscitation at birth. We examined whether physicians sensed low and normal compliance with a self-inflating bag before and after an educational intervention that used a manikin connected to a newborn lung simulator.
  
  
  METHODS
  We asked 43 physicians with neonatal duties to perform two low compliance ventilation attempts and two normal-compliance ventilation attempts in a randomised order at baseline and after the educational intervention, with 34 taking part in a retest three months later.
  
  
  RESULTS
  The physicians correctly recognised low and normal compliance in 71% and 66% of the ventilations at baseline, 80% and 66% of the ventilations after the intervention and 74% and 81% at retest. Correct recognition of normal compliance improved from baseline to retest (p = 0.04). Ventilations in low- vs normal-compliance settings resulted in lower tidal volumes (4.4 vs 23.0 mL, p < 0.001), lower ventilation rates (42 vs 51, p < 0.001) and higher peak inflating pressure (35.2 vs 31.4 cmH2 O, p < 0.001).
  
  
  CONCLUSIONS
  Around one in four physicians failed to recognise correct compliance levels when using a self-inflating bag and showed limited improvement after an educational intervention. Ventilations in a low-compliance setting resulted in suboptimal ventilation.
authors.affiliation: Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Akershus, Norway.|Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway.
authors.forename: Anne Marthe
authors.identifier: http://orcid.org/0000-0003-1066-9405
authors.initials: AM
authors.lastname: Boldingh
authors.affiliation: Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Akershus, Norway.
authors.forename: Anne Lee
authors.initials: AL
authors.lastname: Solevåg
authors.affiliation: Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway.|HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Jūratė Šaltytė
authors.initials: JŠ
authors.lastname: Benth
authors.affiliation: Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway.|Paediatric Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: Claus
authors.initials: C
authors.lastname: Klingenberg
authors.affiliation: Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Akershus, Norway.|Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway.
authors.forename: Britt
authors.initials: B
authors.lastname: Nakstad
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008170:Lung Compliance / Q000502:physiology*; D008297:Male; D008348:Manikins; D009359:Neonatology / Q000592:standards; D012129:Respiratory Function Tests / Q000295:instrumentation
keywords: Compliance; Lung; Manikin; Newborn; Self-inflating bag