Ventilation fraction during the first 30 s of neonatal resuscitation

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• 作者：Christiane Skå ; re^a ; ^{christiane.skare@medisin.uio.no" class="auth_mail" title="E-mail the corresponding author} ; Anne-Marthe Boldingh^b ; ^c ; Britt Nakstad^b ; ^c ; Tor Einar Calisch^d ; Dana E. Niles^e ; Vinay M. Nadkarni^f ; Jo Kramer-Johansen^a ; Theresa M. Olasveengen^a
• 关键词：PPV ; positive pressure ventilation ; CPAP ; continuous positive airways pressure ; NICU ; newborn intensive care unit ; ERC ; European Resuscitation Council ; ILCOR ; International Liaison Committee of Resuscitation ; OUH ; Oslo University Hospital ; AUH ; Akershus University Hospital
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：107
• 期：Complete
• 页码：25-30
• 全文大小：508 K

文摘

Approximately 5% of newborns receive positive pressure ventilation (PPV) for successful transition. Guidelines urge providers to ensure effective PPV for 30–60 s before considering chest compressions and intravenous therapy. Pauses in this initial PPV may delay recovery of spontaneous respiration. The aim was to find the ventilation fraction during the first 30 s of PPV in non-breathing babies.

Methods

Prospective observational study in two hospitals in Norway. All newborns receiving PPV immediately after delivery were included. Cameras with motion detectors were installed at every resuscitation bay capturing both expected and unexpected compromised newborns. We determined the cumulative number of seconds with PPV efforts excluding pauses in infants without spontaneous breathing and reported ventilation fraction during the first minute. Data are presented as median (IQR).

Results

110 of 3508 (3%) newborns received PPV and were filmed in the resuscitation bays. PPV started 42 (18–78) s after arrival at the resuscitation bay and median duration was 100 (35–225) s. Forty-eight infants (44%) were ventilated continuously, or with minimal pause (ventilation fraction >90%) during the first 30 s of PPV. For the remaining 62 infants ventilation fraction was 60% (39–75). PPV was interrupted due to adjustments, checking heart rate, stimulation, administration of CPAP and suctioning.

Conclusion

In 56% of the neonatal resuscitations interruptions in ventilation are frequent with 60% ventilation fraction during the first 30 s of PPV. Eliminating disruption for improved quality of PPV delivery should be emphasized when training newborn resuscitation providers.