Effectiveness of positive pressure ventilation during newborn care unit evacuation (original) (raw)
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Children
Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but pos...
Use of neonatal simulation models to assess competency in bag-mask ventilation
OBJECTIVE: Providing adequate bag-mask ventilation (BMV) is an essential skill for neonatal resuscitation. Often this skill is learned using simulation manikins. Currently, there is no means of measuring the adequacy of ventilation in simulated scenarios. Thus, it is not possible to ascertain proficiency. The first aim of this study was to measure the pressure generated during BMV as performed by providers with different skill levels and measure the impact of different feedback mechanisms. The second aim was to measure the pressure volume characteristics of two neonatal manikins to see how closely they reflect newborn lung mechanics. STUDY DESIGN: In Phase I to achieve the first aim, we evaluated BMV skills in different level providers including residents (n = 5), fellows (n = 5), neonatal nurse practitioners (n = 5) and neonatologists (n = 5). Each provider was required to provide BMV for 2-min epochs on the SimNewB (Laerdal), which had been instrumented to measure pressure-volume characteristics. In sequential 2-min epochs, providers were given different feedback including chest-wall movement alone compared to manometer plus chest-wall movement or chest-wall movement plus manometer plus laptop lung volume depiction. In Phase II of the study we measured pressure-volume characteristics in instrumented versions of the SimNewB (Laerdal) and NeoNatalie (Laerdal). RESULTS: In Phase I, all providers are compared with the neonatologists. All measurements of tidal volume (V t ) are below the desired 5 ml kg − 1 . The greatest difference in V t between the neonatologists and other providers occurs when only chest-wall movement is provided. A linear relationship is noted between V t and PIP for both SimNewB and NeoNatalie. The compliance curves are not 'S-shaped' and are different between the two models (P o0.001). CONCLUSION: Phase I of this study demonstrates that the SimNewB with the feedback of chest-wall movement alone was the best method of distinguishing experienced from inexperienced providers during simulated BMV. Therefore this is likely to be the best method to ascertain proficiency. Phase II of the study shows that the currently available neonatal simulation manikins do not have pressure-volume characteristics that are reflective of newborn lung mechanics, which can result in suboptimal training.
Resuscitation Plus, 2021
Aim Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses. Methods Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10−21 mL) and rate (40–60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10−21 mL...
Advances in Simulation, 2022
Background: Annually, 1.5 million intrapartum-related deaths occur; fresh stillbirths and early newborn deaths. Most of these deaths are preventable with skilled ventilation starting within the first minute of life. Helping Babies Breathe is an educational program shown to improve simulated skills in newborn resuscitation. However, translation into clinical practice remains a challenge. The aim was to describe changes in clinical resuscitation and perinatal outcomes (i.e., fresh stillbirths and 24-h newborn deaths) after introducing a novel simulator (phase 1) and then local champions (phase 2) to facilitate ongoing Helping Babies Breathe skill and scenario simulation training. Methods: This is a 3-year prospective before/after (2 phases) clinical observational study in Tanzania. Research assistants observed all deliveries from September 2015 through August 2018 and recorded labor/newborn information and perinatal outcomes. A novel simulator with automatic feedback to stimulate self-guided skill training was introduced in September 2016. Local champions were introduced in October 2017 to motivate midwives for weekly training, also team simulations. Results: The study included 10,481 births. Midwives had practiced self-guided skill training during the last week prior to a real newborn resuscitation in 34% of cases during baseline, 30% in phase 1, and 71% in phase 2. Most real resuscitations were provided by midwives, increasing from 66% in the baseline, to 77% in phase 1, and further to 83% in phase 2. The median time from birth to first ventilation decreased between baseline and phase 2 from 118 (85-165) to 101 (72-150) s, and time pauses during ventilation decreased from 28 to 16%. Ventilations initiated within the first minute did not change significantly (13-16%). The proportion of high-risk deliveries increased during the study period, while perinatal mortality remained unchanged. Conclusions: This study reports a gradual improvement in real newborn resuscitation skills after introducing a novel simulator and then local champions. The frequency of trainings increased first after the introduction of motivating champions. Time from birth to first ventilation decreased; still, merely 16% of newborns received ventilation within the first minute as recommended. This is a remaining challenge that may require more targeted team-scenario training and quality improvement efforts to improve.
In Situ Simulation Training for Neonatal Resuscitation: An RCT
Pediatrics, 2014
OBJECTIVES: High-fidelity simulation is an effective tool in teaching neonatal resuscitation skills to professionals. We aimed to determine whether in situ simulation training (for ∼80% of the delivery room staff) improved neonatal resuscitation performed by the staff at maternities. METHODS: A baseline evaluation of 12 maternities was performed: a random sample of 10 professionals in each unit was presented with 2 standardized scenarios played on a neonatal high-fidelity simulator. The medical procedures were video recorded for later assessments. The 12 maternities were then randomly assigned to receive the intervention (a 4-hour simulation training session delivered in situ for multidisciplinary groups of 6 professionals) or not receive it. All maternities were evaluated again at 3 months after the intervention. The videos were assessed by 2 neonatologists blinded to the pre-/postintervention as well as to the intervention/control groups. The performance was assessed using a techn...
Paediatrics and Child Health, 2018
RESULTS: A total of 73 surveys were collected, for a final response rate of 38%. The majority (i.e., 81% of parents) reported having a resident involved in the care of their child. Significant findings included that level of education was shown to be directly correlated with knowledge of residents (r = 0.336, p = 0.006). Questions on parental knowledge revealed that 21% of respondents were not aware that residents are physicians. Most parents would like members of the medical team to identify their role. While 70 % of parents reported that residents effectively introduced themselves to them, 29% of desirous parents did not. CONCLUSION: Most parents were familiar with the role of residents in this single-centre, prospective qualitative study. This survey highlights the importance of a clear introduction of the resident's role to parents. Improved awareness of this factor may help residents improve their communication skills, and improve the family's experience in the NICU.
Simulation in Neonatal Resuscitation
Disease-a-Month, 2011
The science behind neonatal resuscitation is growing exponentially. The International Liaison Committee on Resuscitation and its various delegations, specifically the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics, was created in 1987 to establish evidence-based practice guidelines for neonatal resuscitation. Its primary goal was to ensure that at least one person at each hospital birth was trained in neonatal resuscitation. 1 Requirements for certification vary for each individual hospital. In general, individuals working in a labor and delivery unit, level I well-baby nursery, or level II-III neonatal intensive care unit require completion of the NRP by all medical, nursing, and respiratory personnel within 6 months of employment. 2 Every 2 years a typical renewal course would consist of a take-home written examination as well as a 5-minute Megacode with a certified NRP instructor. Anyone new to the NRP or with expired status would have to take a Provider course, consisting of 8 hours of didactics in addition to the Megacode. The NRP has been incredibly successful in educating medical personnel and creating a standard of neonatal resuscitation. However, in 2004, the Joint Commission investigated 47 cases of infant injury or death during delivery. They found that the most common causes were ineffective communication and teamwork. Of the 109 cases, 93 resulted in death, and 16 with significant permanent injury. 3 The following are recommendations based on these findings. 4 : • Team training to teach staff how to work together and communicate more effectively • Clinical drills to help staff prepare for uncommon but high-risk events
Children
Positive pressure ventilation of the non-breathing newborn is a critical and time-sensitive intervention, considered to be the cornerstone of resuscitation. Many healthcare providers working in delivery units in high-resource settings have little opportunity to practise this skill in real life, affecting their performance when called upon to resuscitate a newborn. Low-dose, high-frequency simulation training has shown promise in low-resource settings, improving ventilation performance and changing practice in the clinical situation. We performed a randomised controlled study of low-dose, high-frequency simulation training for maintenance of ventilation competence in a multidisciplinary staff in a busy teaching hospital in Norway. We hypothesised that participants training according to a low-dose, high-frequency protocol would perform better than those training as they wished. Our results did not support this, although the majority of protocol participants were unable to achieve trai...