O35 Simulation to investigate effective airway positioning when neopuffing. (3rd November 2019)

• Record Type: Journal Article
• Authors: Peterson, Jennifer; Gottstein, Ruth; Ranganna, Ranganath
• Is Part Of: BMJ simulation & technology enhanced learning. Volume 5(2019)Supplement 2
• Page Start: A20
• Page End: A21
• Publication Date: 2019-11-03
• Subjects: Medicine -- Simulation methods -- Periodicals; Medical innovations -- Periodicals; 610.113
• DOI: 10.1136/bmjstel-2019-aspihconf.33
• Languages: English
• ISSNs: 2056-6697

Abstract

Abstract : Introduction: There are frequent situations in which our infants requiring face mask ventilation ('Neopuffing'). Traditional 'Neopuffing' of a non-intubated infant involves applying the face mask and Neopuff with the infant in their usual position in the incubator - at 90 degrees to the staff member administering breaths (figure 1 ). Aims: To evaluate if there is a difference between peak inspiratory pressure (PIP) achieved when Neopuffing with infant in-line with staff member or when infant is at 90 degrees to the staff member. To evaluate if staff members consider the in-line manouevre themselves and if so, how long until they move the infant into this position. Methods: PremiHal manikin (Gaumard) was set up in an incubator in a simulation room. Suction and 'Neopuff' were set up with pressures preset to 30/5 cmH2O. The patient monitor screen was set up with a heart rate of 105/min and O2 saturations of 65%. The Gaumard control monitor was turned away so participants could not see. This monitor show adequacy of delivered breaths and records achieved PIP. Over the course of one daytime shift in Nov 2018, nurses and doctors working in NICU were invited to participate in a basic airway skills assessment. This airway assessment was repeated 4 months later in April 2019. Results and conclusions: When possible turning the non–intubated infant in the incubator or coming to the head end of the cot in order to achieve an in–line position with the infant is the most effective way to provide the target PIP (see box and whisker plot). Neopuffing in–line with the infant results in consistently achieved pressures with minimal breath–to–breath variation (breath–to–breath variation only 0.4 cmH2O). When the resuscitator is at 90 degrees to the infant, the achieved PIP is highly variable (breath–to–breath variation of 15cmH20), likely due to mask seal being compromised and uneven pressure applied to mask, reducing the efficacy of breaths delivered as lower, or negligible, PIPs and PEEPs are achieved. Initial project cycle showed that 66% of participants needed a verbal prompt to consider the in–line position, despite not being able achieve target PIP in the 90degree position. Following simulation sessions and education, in the repeat cycle only 14% of participants required prompting.