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Sotiropoulos JX, Vento M, Saugstad OD, Oei JL. The quest for optimum oxygenation during newborn delivery room resuscitation: Is it the baby or is it us? Semin Perinatol 2022; 46:151622. [PMID: 35725654 DOI: 10.1016/j.semperi.2022.151622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Achieving "normal oxygenation" in sick newborn infants requiring resuscitation is one of the most difficult and incompletely informed practices in neonatal care. Suboptimal oxygenation, whether too little or too much, has profound repercussions, including death. In the last two decades, clinicians have lost equipoise for the use of higher oxygen strategies due to concerns of hyperoxia but emerging evidence suggests that lower oxygen strategies may also be as detrimental, especially in infants with pulmonary pathologies such as those born at the cusp of viability. Practice at the coalface using rapidly evolving recommendations has also uncovered continuing complexities in the quest to achieve optimum oxygenation during the first critical minutes of life. There are adjustable factors, such as the practical impediments to acquiring knowledge, equipment and expertise as well as unadjustable factors, such as inherent infant pathology, that necessitates agile clinical manipulation to "first do no harm". This review will address the deficiencies in knowledge that currently impede our quest to determine the best and safest means to deliver oxygen to sick infants during the first critical minutes of life and suggest practical solutions for current practice while awaiting definitive evidence from large scale, well defined, randomized controlled studies.
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Affiliation(s)
- James Xavier Sotiropoulos
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia; Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia
| | - Maximo Vento
- University and Polytechnic Hospital La Fe, Valencia, Spain; Health Research Institute La Fe, Valencia, Spain
| | - Ola D Saugstad
- Northwestern University, Chicago, USA; University of Oslo, Oslo, Norway
| | - Ju Lee Oei
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia; Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia.
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Thio M, Dawson JA, Crossley KJ, Moss TJ, Roehr CC, Polglase GR, Davis PG, Hooper SB. Delivery of positive end-expiratory pressure to preterm lambs using common resuscitation devices. Arch Dis Child Fetal Neonatal Ed 2019; 104:F83-F88. [PMID: 29500315 DOI: 10.1136/archdischild-2017-314064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND In neonatal resuscitation, a ventilation device providing positive end-expiratory pressure (PEEP) is recommended. There is limited information about PEEP delivery in vivo, using different models of self-inflating bag (SIB) at different inflation rates and PEEP settings. METHODS We compared PEEP delivery to intubated preterm lambs using four commonly available models of paired SIBs and PEEP valves, with a T-piece, with gas flow of 8 L/min. Peak inspiratory pressure inflations of 30 cmH2O, combined with set PEEP of 5, 7 and 10 cmH2O, were delivered at rates of 20, 40 and 60/min. These combinations were repeated without gas flow. We measured mean PEEP, maximum and minimum PEEP, and its difference (PEEP reduction). RESULTS A total of 3288 inflations were analysed. The mean PEEP delivered by all SIBs was lower than set PEEP (P<0.001), although some differences were <0.5 cmH2O. In 55% of combinations, the presence of gas flow resulted in increased PEEP delivery (range difference 0.3-2 cmH2O). The mean PEEP was closer to set PEEP with faster inflation rates and higher set PEEPs. The mean (SD) PEEP reduction was 3.9 (1.6), 8.2 (1.8), 2 (0.6) and 1.1 (0.6) cmH2O with the four SIBs, whereas it was 0.5 (0.2) cmH2O with the T-piece. CONCLUSIONS PEEP delivery with SIBs depends on the set PEEP, inflation rate, device model and gas flow. At recommended inflation rates of 60/min, some devices can deliver PEEP close to the set level, although the reduction in PEEP makes some SIBs potentially less effective for lung recruitment than a T-piece.
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Affiliation(s)
- Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia.,PIPER - Neonatal Retrieval Services Victoria, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jennifer A Dawson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly J Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Timothy J Moss
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Charles C Roehr
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Newborn Services, University of Oxford, John Radcliffe Hospital, NHS Foundation Trust, Oxford, UK
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,The Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Izquierdo M, Iriondo M, Ruiz C, Zeballos G, Sánchez M, González E, Vento M, Thió M. Survey of neonatal resuscitation practices showed post-training improvements but need to reinforce preterm management, monitoring and adrenaline use. Acta Paediatr 2017; 106:897-903. [PMID: 28218962 DOI: 10.1111/apa.13791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/25/2016] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
AIM Neonatal resuscitation surveys have showed practice variations between countries, centres and levels of care. We evaluated delivery room practices after a nationwide neonatal resuscitation training programme focused on nontertiary centres. METHODS A 2012 survey sent to all Spanish hospitals handling deliveries covered staff availability and training, equipment and practices in the delivery room and during transfers to neonatal intensive care units. The results from 98 centres that had completed a previous survey in 2007 were analysed by levels of care. Pearson's chi-square test was used to compare the proportions. RESULTS The following had significantly improved in 2012 compared to 2007: the availability of T-piece resuscitators (71.4% vs. 41.8%), plastic wraps (69.4% vs. 31.6%), gas blenders (79.6% vs. 40.8%), pulse oximetry (92.9% vs. 61.2%), use of continuous positive airway pressure (82.7% vs. 43.9%) (all p < 0.01), the availability of instructors (55.6% vs. 83.3%, p < 0.05) and neonatal resuscitation courses (40.8% vs. 79.6%, p < 0.05) in nontertiary centres. In 2012, the use of exhaled carbon dioxide detectors was <7% and endotracheal administration of adrenaline was >90%. CONCLUSION Neonatal resuscitation equipment and practices improved over time, but several aspects needed to be reinforced in training programmes, namely preterm infants' management, monitoring and adrenaline administration.
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Affiliation(s)
- Montserrat Izquierdo
- Division of Neonatology; BCNatal Hospital Sant Joan de Déu-Hospital Clínic; Esplugues de Llobregat (Barcelona) Spain
- Maternal and Infant Health and Development Research Network SAMID (RD 12/0026/0002); Health Research Institute Carlos III; Spanish Ministry of Economy and Competitiveness; Barcelona Spain
| | - Martín Iriondo
- Division of Neonatology; BCNatal Hospital Sant Joan de Déu-Hospital Clínic; Esplugues de Llobregat (Barcelona) Spain
- Maternal and Infant Health and Development Research Network SAMID (RD 12/0026/0002); Health Research Institute Carlos III; Spanish Ministry of Economy and Competitiveness; Barcelona Spain
| | - César Ruiz
- Maternal and Infant Health and Development Research Network SAMID (RD 12/0026/0002); Health Research Institute Carlos III; Spanish Ministry of Economy and Competitiveness; Barcelona Spain
- Division of Neonatology; Hospital de la Vall d'Hebrón; Barcelona Spain
| | - Gonzalo Zeballos
- Division of Neonatology; Hospital General Universitario Gregorio Marañón; Madrid Spain
- Health Research Institute Gregorio Marañón (IiSGM); CIBEREHD; Madrid Spain
| | - Miguel Sánchez
- Division of Neonatology; Hospital Puerta del Hierro; Majadahonda (Madrid) Spain
| | - Eva González
- Division of Neonatology; Hospital Alvaro Cunqueiro; Beade (Pontevedra) Spain
- Biomedical Research Institute University of Santiago de Compostela; La Coruña Spain
| | - Máximo Vento
- Maternal and Infant Health and Development Research Network SAMID (RD 12/0026/0002); Health Research Institute Carlos III; Spanish Ministry of Economy and Competitiveness; Barcelona Spain
- Division of Neonatology; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Marta Thió
- Department of Newborn Research; The Royal Women's Hospital; Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology; The University of Melbourne; Melbourne Victoria Australia
- PIPER - Neonatal Retrieval Services; The Royal Children's Hospital; Melbourne Victoria Australia
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Sugiura T, Urushibata R, Komatsu K, Shioda T, Ota T, Sato M, Okubo Y, Fukuoka T, Hosono S, Tamura M. Oxygen delivery using neonatal self-inflating bags without reservoirs. Pediatr Int 2017; 59:154-158. [PMID: 27706892 DOI: 10.1111/ped.13184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Guidelines recommend avoiding excessive oxygen during neonatal resuscitation. Recent studies have suggested that oxygen titration can be achieved using a self-inflating bag, but data on the effectiveness of resuscitators used in neonatal ventilation are scarce, The aim of this study was therefore to determine the amount of oxygen delivered using several brands of neonatal self-inflating resuscitation bags without reservoirs under different conditions with regard to oxygen flow rate, ventilation rate (VR), peak inspiratory pressure (PIP) range, and test lung compliance. METHODS Oxygen concentration was measured under a variety of conditions. Combinations of oxygen flow rate (10, 5.0, 3.0 and 1.0 L/min), VR (40, 60 inflations/min), PIP range (20-25 cmH2 O, 35-40 cmH2 O), and test lung compliance (0.6, 1.0, 3.0, and 5.0 mL/cmH2 O) were examined using six kinds of self-inflating bag. RESULTS Delivered oxygen concentration varied widely (30.1-96.7%) and had a significant positive correlation with gas flow rate in all of the bags. Delivered oxygen concentration was also negatively correlated with PIP in all of the bags and with VR in some of them. Test lung compliance did not affect delivered oxygen concentration. CONCLUSION The use of neonatal resuscitation self-inflating bags without reservoirs resulted in different delivered oxygen concentrations depending on gas flow rate, VR, PIP, and manufacturer, but not on lung compliance. This suggests that targeted oxygen concentrations could be delivered, even in lungs with decreased compliance, during resuscitation.
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Affiliation(s)
- Takahiro Sugiura
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan.,Committee for Cardiopulmonary Resuscitation of the Japan Society of Fetal and Neonatal Medicine, Tokyo, Japan
| | - Rei Urushibata
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kenji Komatsu
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Tsutomu Shioda
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Tatsuki Ota
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Megumi Sato
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Yumiko Okubo
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Tetsuya Fukuoka
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Shigeharu Hosono
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.,Committee for Cardiopulmonary Resuscitation of the Japan Society of Fetal and Neonatal Medicine, Tokyo, Japan
| | - Masanori Tamura
- Committee for Cardiopulmonary Resuscitation of the Japan Society of Fetal and Neonatal Medicine, Tokyo, Japan.,Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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