1
|
Holte K, Ersdal HL, Eilevstjønn J, Thallinger M, Linde J, Klingenberg C, Holst R, Jatosh S, Kidanto H, Stordal K. Predictors for expired CO 2 in neonatal bag-mask ventilation at birth: observational study. BMJ Paediatr Open 2019; 3:e000544. [PMID: 31646198 PMCID: PMC6783122 DOI: 10.1136/bmjpo-2019-000544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Expired carbon dioxide (ECO2) indicates degree of lung aeration immediately after birth. Favourable ventilation techniques may be associated with higher ECO2 and a faster increase. Clinical condition will however also affect measured values. The aim of this study was to explore the relative impact of ventilation factors and clinical factors on ECO2 during bag-mask ventilation of near-term newborns. METHODS Observational study performed in a Tanzanian rural hospital. Side-stream measures of ECO2, ventilation data, heart rate and clinical information were recorded in 434 bag-mask ventilated newborns with initial heart rate <120 beats per minute. We studied ECO2 by clinical factors (birth weight, Apgar scores and initial heart rate) and ventilation factors (expired tidal volume, ventilation frequency, mask leak and inflation pressure) in random intercept models and Cox regression for time to ECO2 >2%. RESULTS ECO2 rose non-linearly with increasing expired tidal volume up to >10 mL/kg, and sufficient tidal volume was critical for the time to reach ECO2 >2%. Ventilation frequency around 30/min was associated with the highest ECO2. Higher birth weight, Apgar scores and initial heart rate were weak, but significant predictors for higher ECO2. Ventilation factors explained 31% of the variation in ECO2 compared with 11% for clinical factors. CONCLUSIONS Our findings indicate that higher tidal volumes than currently recommended and a low ventilation frequency around 30/min are associated with improved lung aeration during newborn resuscitation. Low ECO2 may be used to identify unfavourable ventilation technique. Clinical factors are also associated with persistently low ECO2 and must be accounted for in the interpretation.
Collapse
Affiliation(s)
- Kari Holte
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Joar Eilevstjønn
- Strategic Research, Laerdal Medical AS, Stavanger, Rogaland, Norway
| | - Monica Thallinger
- Department of Anesthesiology and Intensive Care, Bærum Hospital, Vestre Viken HF, Bærum, Norway
| | - Jørgen Linde
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Paediatrics and Adolescence Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
- Paediatric Research Group, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
| | - Rene Holst
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
- Research Department, Østfold Hospital Trust, Grålum, Norway
| | - Samwel Jatosh
- Research Department, Haydom Lutheran Hospital, Mbulu, Tanzania
| | - Hussein Kidanto
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Medical college, Aga Khan University Hospital, Dar es Salaam, Tanzania
| | - Ketil Stordal
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
2
|
O'Donnell CPF, Schmölzer GM. Resuscitation of preterm infants: delivery room interventions and their effect on outcomes. Clin Perinatol 2012; 39:857-69. [PMID: 23164183 DOI: 10.1016/j.clp.2012.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite advances in neonatal care, the rate of oxygen dependence at 36 weeks' postmenstrual age or bronchopulmonary dysplasia has not fallen. Neonatologists are increasingly careful to apply ventilation strategies that are gentle to the lung in the neonatal intensive care unit. However, there has not been the same emphasis applying gentle ventilation strategies immediately after birth. A lung-protective strategy should start immediately after birth to establish a functional residual capacity, reduce volutrauma and atelectotrauma, facilitate gas exchange, and improve oxygenation during neonatal transition. This article discusses techniques and equipment recommended by international resuscitation guidelines during breathing assistance in the delivery room.
Collapse
Affiliation(s)
- Colm P F O'Donnell
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | | |
Collapse
|