Variability in the assessment of 'adequate' chest excursion during simulated neonatal resuscitation

Neonatology. 2011;100(1):99-104. doi: 10.1159/000322009. Epub 2011 Feb 9.


Background: International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing 'adequate' chest excursion lacks objectivity.

Aim: It was the aim of this study to test the accuracy in the assessment of 'adequate' chest excursion by measuring intra- and inter-observer variability of participants during simulated neonatal resuscitation.

Methods: Thirty-seven staff members (8 neonatologists, 8 registrars, 21 nurses) of the Neonatal Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands, ventilated 2 different intubated, leak-free manikins at 2 attempts, each with a different compliance. Blinded to the manometer, participants could change the peak inflation pressure until chest movement was adequate according to their perception. Inflating pressures were recorded.

Results: According to the participants, a median (interquartile range) pressure of 18 cm H2O (16-22) at the first and 18 cm H2O (16-25) at the second attempt were needed to reach adequate chest excursion in the Laerdal manikin. The HAL manikin needed 26 cm H2O (19-31) and 24 cm H2O (22-33), respectively. The inter-observer coefficient of variance was 30% with the Laerdal manikin at both attempts, and 35 and 40% with the HAL manikin, respectively. The intra-observer coefficient of variance was 15% (8-23) with the Laerdal and 13% (9-20) with the HAL manikin. In both manikins and attempts, no significant differences in pressures and variances of pressures between the 3 groups were found.

Conclusion: 'Adequate' chest excursion is a subjective parameter for guidance of appropriate ventilation during neonatal resuscitation.

Publication types

  • Evaluation Study

MeSH terms

  • Chest Wall Oscillation / methods
  • Chest Wall Oscillation / standards
  • Clinical Competence
  • Guideline Adherence / standards
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / therapy*
  • Manikins
  • Medical Staff, Hospital
  • Neonatology
  • Observer Variation
  • Reproducibility of Results
  • Resuscitation / methods*
  • Resuscitation / standards*
  • Resuscitation / statistics & numerical data
  • Thorax
  • Ventilators, Mechanical
  • Workforce