Artigo Revisado por pares

Variability in the Assessment of ‘Adequate’ Chest Excursion during Simulated Neonatal Resuscitation

2011; Karger Publishers; Volume: 100; Issue: 1 Linguagem: Inglês

10.1159/000322009

ISSN

1661-7819

Autores

María Brugada, Kim Schilleman, Ruben S. G. M. Witlox, Frans J. Walther, Máximo Vento, Arjan B. te Pas,

Tópico(s)

Trauma and Emergency Care Studies

Resumo

<i>Background:</i> International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing ‘adequate’ chest excursion lacks objectivity. <i>Aim:</i> It was the aim of this study to test the accuracy in the assessment of ‘adequate’ chest excursion by measuring intra- and inter-observer variability of participants during simulated neonatal resuscitation. <i>Methods:</i> Thirty-seven staff members (8 neonatologists, 8 registrars, 21 nurses) of the Neonatal Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands, ventilated 2 different intubated, leak-free manikins at 2 attempts, each with a different compliance. Blinded to the manometer, participants could change the peak inflation pressure until chest movement was adequate according to their perception. Inflating pressures were recorded. <i>Results:</i> According to the participants, a median (interquartile range) pressure of 18 cm H<sub>2</sub>O (16–22) at the first and 18 cm H<sub>2</sub>O (16–25) at the second attempt were needed to reach adequate chest excursion in the Laerdal manikin. The HAL manikin needed 26 cm H<sub>2</sub>O (19–31) and 24 cm H<sub>2</sub>O (22–33), respectively. The inter-observer coefficient of variance was 30% with the Laerdal manikin at both attempts, and 35 and 40% with the HAL manikin, respectively. The intra-observer coefficient of variance was 15% (8–23) with the Laerdal and 13% (9–20) with the HAL manikin. In both manikins and attempts, no significant differences in pressures and variances of pressures between the 3 groups were found. <i>Conclusion:</i> ‘Adequate’ chest excursion is a subjective parameter for guidance of appropriate ventilation during neonatal resuscitation.

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