title: The effectiveness of Ambu neonatal self-inflating bag to provide consistent positive end-expiratory pressure.
abstract: BACKGROUND
  The self-inflating bag (SIB) is the most common device used to resuscitate newborn infants worldwide. Delivering positive end-expiratory pressure (PEEP) may be important in infant resuscitation and limited research using one brand (Laerdal) SIB has led to international guidelines stating SIBs 'often deliver inconsistent positive end-expiratory pressure'.
  
  
  OBJECTIVE
  To measure delivered PEEP using disposable and reusable Ambu SIBs fitted with Ambu PEEP valve and manometer comparing different rates of 20, 40 and 60 inflations per minute (IPM) and test lung compliance.
  
  
  METHODS
  Three experienced neonatal medical staff provided positive pressure ventilation each using different disposable and reusable Ambu SIBs, targeting peak inflation pressure of 30-35 cm H2O at three different set PEEP levels of 5, 7.5 and 10 cm H2O on test lungs of compliance of 0.5 and 3.0 mL/cm H2O. Inflation data were captured with Florian Monitor and analysed by analysis of variance for repeated measures.
  
  
  RESULTS
  A total of 3265 inflations were analysed. The delivered PEEP was rate and lung compliance dependent. At set PEEP of 5 cm H2O, the adjusted measured PEEP was 3.6, 4.4 and 4.8 cm H2O at rates 20, 40 and 60 IPM, respectively, while at set PEEP of 10 cm H2O, the adjusted measured PEEP was 7.0, 8.8 and 9.8 cm H2O. The delivered PEEP was statistically higher with more compliant test lungs.
  
  
  CONCLUSIONS
  The Ambu SIB with Ambu PEEP valve can deliver consistent mean levels of PEEP close to the operator set PEEP. The performance of SIB with PEEP valves is likely brand specific and requires further evaluation.
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia Department of Paediatrics and Child Health, Sydney University, Westmead, New South Wales, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Tracy
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia Sydney University, New South Wales, Australia.
authors.forename: Dharmesh
authors.initials: D
authors.lastname: Shah
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia Sydney University, New South Wales, Australia.
authors.forename: Archana
authors.initials: A
authors.lastname: Priyadarshi
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia Sydney University, New South Wales, Australia.
authors.forename: Murray
authors.initials: M
authors.lastname: Hinder
mesh_terms: D004867:Equipment Design; D006801:Humans; D007231:Infant, Newborn; D007327:Insufflation / Q000295:instrumentation; D008170:Lung Compliance; D008365:Manometry; D011175:Positive-Pressure Respiration / Q000295:instrumentation*
keywords: PEEP; Resuscitation; newborn; peak inspiratory pressure; self-inflating bag