Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision

Excessive peak inspiratory pressures (PIP) and high tidal volumes (Vt) during manual ventilation can be detrimental to the neonatal lung. We compared the influence of different manual ventilation devices and individual professional experience on the extent of applied Vt and PIP in simulated neonatal resuscitation.

One hundred and twenty medical professionals were studied. An intubated mannequin (equivalent to 1.0 kg neonate) was ventilated using two different devices: a self-inflating bag and a T-piece resuscitator. Target value was a PIP of 20 cm H(2)O. Applied PIP and the resulting Vt were recorded continuously using a respiratory function monitor (CO(2)SMO(+), Novametrix, USA).

Vt and PIP provision was significantly higher in SI-bags, compared to T-piece devices: median (interquartile range) PIP 25.6 (18.2) cm H(2)O vs 19.7 (3.2) cm H(2)O (p<0.0005), and Vt 5.1(3.2) ml vs Vt 3.6 (0.8) ml (p<0.0005) respectively. The intersubject variability of Vt and PIP provision was distinctly higher in SI-bags, compared to T-piece devices. Professional experience had no significant impact on the level and the variability of Vt or PIP provided.

Use of T-piece devices guarantees reliable and constant Vt and PIP provision, irrespective of individual, operator dependent variables. Methods to measure and to avoid excessive tidal volumes in neonatal resuscitation need to be developed.