title: Neonatal ventilation with a manikin model and two novel PEEP valves without an external gas source.
abstract: OBJECTIVE
  Positive end expiratory pressure (PEEP) is beneficial when ventilating preterm newborns. The aim was to study whether inexperienced providers were able to generate PEEP during simulated neonatal ventilation, using two novel prototype PEEP valves, on a self-inflating bag without an external gas source.
  
  
  METHODS
  Forty-six nursing students in Tanzania were trained in ventilation with a new Laerdal Upright resuscitator and mask on a NeoNatalie manikin with a newborn resuscitation monitor. Ventilation was studied with and without PEEP valve 1 (anticipated level 4-5 cm H2O) and with and without PEEP valve 2 (anticipated level 9-10 cm H2O) in random order for normal and low 'lung' compliance. The PEEP valves were concave silicone valves with a small slit that would open to let expiratory air out.
  
  
  RESULTS
  Mean PEEP with PEEP1 was 4.4 cm H2O (SD 2.2) and with PEEP2 was 4.9 cm H2O (SD 3.1). PEEP ≥4 cm H2O was generated with 70% of inflations with PEEP1 and 65% with PEEP2. Mean airway pressure was 16.3 cm H2O with both PEEP valves compared with 14.2 without PEEP (p<0.001). Mean mask leak was similar with and without PEEP (48% with PEEP1, 58% with PEEP2, 55% without PEEP). Mask leak and PEEP were inversely correlated. Findings with normal and low 'lung' compliance were similar.
  
  
  CONCLUSIONS
  PEEP between 4 cm H2O and 5 cm H2O was achieved when ventilating a neonatal manikin using a self-inflating bag and novel PEEP valves. Valves that can generate PEEP without external gas sources may aid resuscitation in resource-limited settings.
authors: Faculty of Medicine, Institute of Clinical Medicine, Institute for Experimental Medical Research, University of Oslo, Oslo, Norway.
authors: Monica
authors: M
authors: Thallinger
authors: SAFER, Stavanger, Norway.|Department of Anaesthesiology & Intensive Care, Stavanger University Hospital, Stavanger, Norway.
authors: Hege Langli
authors: HL
authors: Ersdal
authors: Department of Obstetrics & Gynaecology, University of Cambridge, Cambridge, UK.
authors: Colin
authors: C
authors: Morley
authors: Department of Strategic Research, Laerdal Medical AS, Stavanger, Norway.
authors: Carolyn
authors: C
authors: Purington
authors: Department of Strategic Research, Laerdal Medical AS, Stavanger, Norway.
authors: Øystein
authors: Ø
authors: Gomo
authors: Research Centre, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania.
authors: Estomih
authors: E
authors: Mduma
authors: Department of Strategic Research, Laerdal Medical AS, Stavanger, Norway.
authors: Joar
authors: J
authors: Eilevstjønn
authors: Department of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.|Ostfold Hospital Trust, Fredrikstad, Norway.
authors: Ketil
authors: K
authors: Størdal
mesh_terms: D002983:Clinical Competence; D004506:Education, Nursing / Q000379:methods; D004867:Equipment Design; D006801:Humans; D007224:Infant Care / Q000295:instrumentation* / Q000379:methods; D007231:Infant, Newborn; D008170:Lung Compliance; D008348:Manikins; D008397:Masks; D017283:Neonatal Nursing / Q000193:education*; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D011897:Random Allocation; D013636:Tanzania
keywords: Neonatology; Resuscitation