Traditional Poster Round
Background: Our unit is a large tertiary neonatal unit dealing with unstable, acutely unwell infants daily. There are frequent situations in which our infants requiring Neopuffing. From experience on the unit and during our regular simulation teaching sessions, the usual method of bagging a non-intubated infant in an incubator is to apply the mask to the infants face and attempt to Neopuff with the infant in usual position in the incubator and consequently at 90 degrees to the staff member attempting to resuscitate (see Appendix for illustration of “in-line” versus “90 degree” positioning). However, in this position the pressure applied to the mask to create the seal is compromised and prone to being uneven, making leaks likely and reducing the efficacy of the breaths delivered, as lower or negligible PIP and PEEP are achieved.
Setup: I set up our PremiHal manikin (Gaumard) in an incubator in our simulation room. There was suction and a Neopuff setup ready and working. Pressures were preset to 30/5. The monitor screen was set to a heart rate of 105bpm and saturations set to 65%. The control monitor that comes with the Gaumard manikin was turned so participants could not see. This monitor is able to show whether an effective breath is delivered and can record the achieved PIP breath-to-breath.
During one dayshift clinical staff were pulled from the NICU for a 5-minute airway station. They were given a simple scenario in which they were required to bag the baby due to apnoea with associated desaturation to 65% and bradycardia to 105bpm.
The time taken to achieve PIP and maximum PIP achieved with the infant at 90 degrees and in-line were recorded.
1. When possible turning the infant in the incubator or coming to the head end of the cot in order to achieve an in-line position with the infant is the most effective way to provide the target PIP for a non-intubated infant.
2. Maximum PIP achieved at 90 degrees was 5 - 22 versus when in-line maximum PIP achieved was consistently 30.
3. Neopuffing in-line with the infant also ensures consistently achieved pressures with minimal breath-to-breath variation, compared to bagging at 90 degrees to the infant where PIP achieved is highly variable.
• When at 90 degrees variation in PIP was 0 – 22, with breath-to-breath variation of 15 cmH2O on average.
• When in-line, variation in PIP was minimal 28-30, with breath-to-breath variation of 0.4 cmH2O on average.