1004 Three Different Mask Holds for Positive Pressure Ventilation in a Neonatal Mannequin

Abstract

Background and Aim Mask ventilation is commonly used for neonatal resuscitation. Variable leak and inconsistent tidal volumes are reported in mannequin and delivery room studies. We compared the spider hold (SH) against the two-point top hold (TPTH), and two-handed hold (THH) for delivering positive pressure ventilation (PPV).
Methods 53 participants from 5 professional groups provided PPV with each hold for 1 minute to a mannequin, using a T-piece resuscitator (PIP/PEEP 30/5 cmH2O, 40–60 inflations/min). Mask leak and expired tidal volume (TVE) were measured with a flow sensor. ANOVA was used to compare the average median leak from each participant for each hold and by professional group.
Results 7324 inflations were analysed.
The mean (SD) leak was 35(27)%, 38(34)% and 39(33)% for the TPTH, SH and THH respectively (p=0.003). The mean (SD) TVE was not significantly different between the three holds (p=0.09). The lowest mean (SD) leak was measured with the THH by registrars 13(14)% and highest by midwives with the THH 48(36)% (p=0.001).
Conclusion Each hold can be used to give PPV. The SH does not appear to reduce leak when compared to the other holds.

Full text

A288 Arch Dis Child 2012;97(Suppl 2):A1–A539
Abstracts
and two-handed hold (THH) for delivering positive pressure venti-
lation (PPV).
Methods 53 participants from 5 professional groups provided PPV
with each hold for 1 minute to a mannequin, using a T-piece resus-
citator (PIP/PEEP 30/5 cmH2O, 40–60 inflations/min). Mask leak
and expired tidal volume (TVE) were measured with a flow sensor.
ANOVA was used to compare the average median leak from each
participant for each hold and by professional group.
Results 7324 inflations were analysed.
Abstract 1004 Table 1 Leak (%) mean(SD)
Professional Group
TPTH n=2554
inflations
SH n=2384
inflations
THH n=2406
inflations
Consultant n=10 34(28) 39(40) 45 35)
Fellow n=10 33(27) 32(32) 33(35)
Registrar n=10 31(22) 38(23) 13(14)
Midwife n=12 40(30) 43(36) 48(36)
Neonatal nurse n=11 35(28) 38(34) 40(33)
The mean (SD) leak was 35(27)%, 38(34)% and 39(33)% for the
TPTH, SH and THH respectively (p=0.003). The mean (SD) TVE
was not significantly different between the three holds (p=0.09).
The lowest mean (SD) leak was measured with the THH by regis-
trars 13(14)% and highest by midwives with the THH 48(36)%
(p=0.001).
Conclusion Each hold can be used to give PPV. The SH does not
appear to reduce leak when compared to the other holds.
CALCULATED INHALED ALBUTEROL DOSE AND DELIVERED
ALBUTEROL DOSE DURING SIMULATED INFANT
VENTILATION USING A NOVEL VENTILATOR CIRCUIT
CONNECTOR
doi:10.1136/archdischild-2012-302724.1005
1J Mazela, 1K Chmura, 2M Kulza, 2E Florek, 3TJ Gregory, 3C Henderson, 4M Keszler.
1Neonatology; 2Laboratory of Environmental Research, Poznan University of Medical
Sciences, Poznan, Poland; 3Research and Development, Discovery Laboratories, Inc.;
4Brown University, Women and Infants Hospital, Warrington, PA, USA
Background Dose determination of aerosolized medications
administered to ventilated infants is based on nominal dose and not
on the calculated target inhaled dose. A novel ventilator circuit
connector (VCC) (AFECTAIR®, Discovery Laboratories, Inc. War-
rington, PA), has been developed to facilitate inhaled therapies to
ventilated patients.
Objective The aim of the study was to evaluate the difference
between the calculated inhaled dose (ID) and the actual delivered
dose (DD) in an in vitro simulated infant ventilation system using
the VCC vs standard of care (SoC).
Design/methods Albuterol sulfate (AS) was aerosolized with a jet
nebulizer and delivered using SoC and VCC. Aerosolized AS was
collected on HME filters placed before a test lung under different
ventilation conditions. DD was determined by rinsing the filters
and using an HPLC assay for AS. The calculated ID was determined
using the formula: ID=Ca*Vm, (Ca=aerosol concentration, Vm=m
inute ventilation).
Results There was a 10–14 fold increase in the in vitro DD of AS at
various ventilation conditions when using the VCC compared with
SoC. The difference between the calculated ID and the measured
DD in vitro ranged from –42% to 15% for the VCC and from –388%
to –158% for SoC.
Conclusions The VCC delivered a higher AS dose in vitro that was
more representative of the calculated ID compared with SoC. The
1005
the expected range of 0.11–2.27/100 ventilator days1, we identified
staffing levels and sedation as key areas which appeared to have
some causal effect on these numbers. Following the audit, staff
were made aware of the increase in UE’s and the importance of pre-
vention was highlighted.
Results Between May 2011 and March 2012. all incident forms
were examined and those relating to ‘accidental extubations’ or
‘tube displacement’ were examined in more detail. During this time
period it was noted that the UE rate was 0.65/100 ventilator days.
Conclusion Despite reviewing the sedation policy and staffing lev-
els, the UE rate remains unchanged. It is possible that the height-
ened awareness of staff has increased the reporting rate but there is
no evidence of this. Although our UE rate remains low we will con-
tinue to examine each case individually and review practice as
necessary.
1. da Silva et al 2010. Pediatr Crit Care Med. Unplanned extubation
in pediatric critically ill patients.
RANDOMIZED CONTROLLED TRIAL ON EARLY L-CARNITINE
SUPPLEMENTATION TO PRETERM NEWBORNS WITH
RESPIRATORY DISTRESS SYNDROME. DOES IT INFLUENCE
NEONATAL WELLBEING?
doi:10.1136/archdischild-2012-302724.1003
R Said, M Abd El Meguid, D Mosallam, M Mahmoud, Neonatology. Pediatrics &
Neonatology, Faculty of Medicine Cairo University, Cairo, Egypt
Background and Aim Respiratory distress syndrome (RDS) is the
most common cause of respiratory failure and requirement for
mechanical ventilation (MV) of newborns. L-carnitine is essential
for the processes underlying fetal maturation such as surfactant
synthesis. This study aims to study the effect of early carnitine
supplementation on respiratory, nutritional, hematological param-
eters in preterm neonates with respiratory distress syndrome.
Methods This study was conducted on 60 preterm infants
30–33 weeks of gestation presenting with RDS divided randomly
into 2 groups: group A comprised 30 preterm infants who received
I.V. L-carnitine at a dose of 30mg/Kg/day until oral intake was
established; then it was given orally at the same dose, group B com-
prised 30 preterm infants who did not receive L-carnitine. Labora-
tory and radiological investigations were done to confirm RDS, to
evaluate and to follow up growth pattern, hematological, and respi-
ratory outcome in those neonates.
Results L-Carnitine supplementation resulted in significant
increase in weight gain, decreased period of stay on mechanical ven-
tilator and duration of hospital stay as well as improved discharge
status in group A.
Conclusion L-carnitine could be routinely used for preterm neo-
nates suffering from RDS to reduce the need of mechanical ventila-
tion and oxygen requirements in addition to its role in growth.
However its effects on hematological parameters should be traced
in further research work.
THREE DIFFERENT MASK HOLDS FOR POSITIVE PRESSURE
VENTILATION IN A NEONATAL MANNEQUIN
doi:10.1136/archdischild-2012-302724.1004
1EV Wilson, 1JE O’Shea, 1M Thio, 1,2JA Dawson, 2R Boland, 1,2,3PG Davis. 1Newborn
Research, The Royal Women’s Hospital; 2The Murdoch Childrens Research Institute,
Parkville; 3University of Melbourne, Melbourne, VIC, Australia
Background and Aim Mask ventilation is commonly used for
neonatal resuscitation. Variable leak and inconsistent tidal volumes
are reported in mannequin and delivery room studies. We com-
pared the spider hold (SH) against the two-point top hold (TPTH),
1003
1004
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MannequinPressure Ventilation in a Neonatal
1004 Three Different Mask Holds for Positive
EV Wilson, JE O'Shea, M Thio, JA Dawson, R Boland and PG Davis
doi: 10.1136/archdischild-2012-302724.1004
2012 97: A288 Arch Dis Child
http://adc.bmj.com/content/97/Suppl_2/A288.2
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