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

Abstract

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.