Abstract
Our aim was to determine whether neonatal trainees found respiratory function monitoring (RFM) helpful during the resuscitation of prematurely born infants, what decisions they made on the basis of RFM and whether those decisions were evidence based. Fifty one trainees completed an electronic questionnaire. Eighty-three percent found the tidal volume display useful, 59 % altered the inflation pressure based on the tidal volume: 52 % considered 5 ml/kg adequate; 33 % 4 ml/kg; 13 % 6 ml/kg; and 2 % 7 ml/kg, despite no evidence on which to decide was the optimum tidal volume. If there was no detectable expired carbon dioxide (CO2), 30 trainees said they would reintubate, yet the absence of expired CO2 can indicate inadequate vasodilation of the pulmonary circulation rather than inappropriate placement of the endotracheal tube. If there was no chest wall expansion, but expired CO2, a third of junior trainees would reintubate which is inappropriate. If the oxygen saturation (SaO2) was <85 % at 1 min, no senior trainee, but 50 % of junior trainees would increase the inspired oxygen. The majority of healthy babies have an SaO2 > 85 % by 1 min. Conclusions: The usefulness of respiratory function monitoring for trainees during neonatal resuscitation is often not evidence based.
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Abbreviations
- CO2 :
-
Carbon dioxide
- FiO2 :
-
Fraction of inspired oxygen concentration
- PaCO2 :
-
Arterial carbon dioxide tension
- RFM:
-
Respiratory function monitoring
- SaO2 :
-
Arterial oxygen saturation
- SpO2 :
-
Peripheral capillary oxygen saturation
- VT:
-
Volume targeting
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Acknowledgments
This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Dr Murthy was supported by the Guy’s and St Thomas’ Charity. AG is an NIHR Senior Investigator.
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Milner, A., Murthy, V., Bhat, P. et al. Evaluation of respiratory function monitoring at the resuscitation of prematurely born infants. Eur J Pediatr 174, 205–208 (2015). https://doi.org/10.1007/s00431-014-2379-2
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DOI: https://doi.org/10.1007/s00431-014-2379-2