title: Use of neonatal simulation models to assess competency in bag-mask ventilation.
abstract: OBJECTIVE
  Providing adequate bag-mask ventilation (BMV) is an essential skill for neonatal resuscitation. Often this skill is learned using simulation manikins. Currently, there is no means of measuring the adequacy of ventilation in simulated scenarios. Thus, it is not possible to ascertain proficiency. The first aim of this study was to measure the pressure generated during BMV as performed by providers with different skill levels and measure the impact of different feedback mechanisms. The second aim was to measure the pressure volume characteristics of two neonatal manikins to see how closely they reflect newborn lung mechanics.
  
  
  METHODS
  In Phase I to achieve the first aim, we evaluated BMV skills in different level providers including residents (n=5), fellows (n=5), neonatal nurse practitioners (n=5) and neonatologists (n=5). Each provider was required to provide BMV for 2-min epochs on the SimNewB (Laerdal), which had been instrumented to measure pressure-volume characteristics. In sequential 2-min epochs, providers were given different feedback including chest-wall movement alone compared to manometer plus chest-wall movement or chest-wall movement plus manometer plus laptop lung volume depiction. In Phase II of the study we measured pressure-volume characteristics in instrumented versions of the SimNewB (Laerdal) and NeoNatalie (Laerdal).
  
  
  RESULTS
  In Phase I, all providers are compared with the neonatologists. All measurements of tidal volume (Vt) are below the desired 5 ml kg(-1). The greatest difference in Vt between the neonatologists and other providers occurs when only chest-wall movement is provided. A linear relationship is noted between Vt and PIP for both SimNewB and NeoNatalie. The compliance curves are not 'S-shaped' and are different between the two models (P<0.001).
  
  
  CONCLUSIONS
  Phase I of this study demonstrates that the SimNewB with the feedback of chest-wall movement alone was the best method of distinguishing experienced from inexperienced providers during simulated BMV. Therefore this is likely to be the best method to ascertain proficiency. Phase II of the study shows that the currently available neonatal simulation manikins do not have pressure-volume characteristics that are reflective of newborn lung mechanics, which can result in suboptimal training.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Christiana Care Health System, Newark, DE, USA.|Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Pearlman
authors.affiliation: Academic Affairs Virtual Education and Simulation Training Center, Christiana Care Health System, Newark, DE, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Zern
authors.affiliation: Academic Affairs-Allied Health Education, Respiratory Care, Christiana Care Health System, Newark DE, USA.
authors.forename: T
authors.initials: T
authors.lastname: Blackson
authors.affiliation: Academic Affairs-Allied Health Education, Respiratory Care, Christiana Care Health System, Newark DE, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Ciarlo
authors.affiliation: Division of Neonatology, Department of Pediatrics, Christiana Care Health System, Newark, DE, USA.|Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Mackley
authors.affiliation: Division of Neonatology, Department of Pediatrics, Christiana Care Health System, Newark, DE, USA.|Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Locke
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002983:Clinical Competence / Q000592:standards*; D004867:Equipment Design; D006801:Humans; D008348:Manikins; D008397:Masks; D061214:Patient Safety / Q000592:standards*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods*; D013990:Tidal Volume