Assessment of resistance of nasal continuous positive airway pressure interfaces.
Arch Dis Child Fetal Neonatal Ed. 2019 Sep;104(5):F535-F539
Authors: Green EA, Dawson JA, Davis PG, De Paoli AG, Roberts CT
OBJECTIVE: To compare the resistance of interfaces used for the delivery of nasal continuous positive airway pressure (CPAP) in neonates, as measured by the generated system pressure at fixed gas flows, in an in vitro setting.
DESIGN: Gas flows of 6, 8 and 10 L/min were passed through three sizes of each of a selection of available neonatal nasal CPAP interfaces (Hudson prong, RAM Cannula, Fisher & Paykel prong, Infant Flow prong, Fisher & Paykel mask, Infant Flow mask). The expiratory limb was occluded and pressure differential measured using a calibrated pressure transducer.
RESULTS: Variation in resistance, assessed by mean pressure differential, was seen between CPAP interfaces. Binasal prong interfaces typically had greater resistance at the smallest assessed sizes, and with higher gas flows. However, Infant Flow prongs produced low pressures (<1.5 cmH2O) at all sizes and gas flows. RAM Cannula had a high resistance, producing a pressure >4.5 cmH2O at all sizes and gas flows. Both nasal mask interfaces had low resistance at all assessed sizes and gas flows, with recorded pressure <1 cmH2O in all cases.
CONCLUSIONS: There is considerable variation in measured resistance of available CPAP interfaces at gas flows commonly applied in clinical neonatal care. Use of interfaces with high resistance may result in a greater drop in delivered airway pressure in comparison to set circuit pressure, which may have implications for clinical efficacy. Device manufacturers and clinicians should consider CPAP interface resistance prior to introduction into routine clinical care.
PMID: 30567774 [PubMed - indexed for MEDLINE]
Appraisal of a scoring instrument for training and testing neonatal intubation skills.
Arch Dis Child Fetal Neonatal Ed. 2019 Sep;104(5):F521-F527
Authors: Bouwmeester RN, Binkhorst M, Yamada NK, Geurtzen R, van Heijst AFJ, Halamek LP, Draaisma JMT, Hogeveen M
OBJECTIVE: To determine the validity, reliability, feasibility and applicability of a neonatal intubation scoring instrument.
DESIGN: Prospective observational study.
SETTING: Simulation-based research and training centre (Center for Advanced Pediatric and Perinatal Education), California, USA.
SUBJECTS: Forty clinicians qualified for neonatal intubation.
INTERVENTIONS: Videotaped elective intubations on a neonatal patient simulator were scored by two independent raters. One rater scored the intubations twice. We scored the preparation of equipment and premedication, intubation performance, tube position/fixation, communication, number of attempts, duration and successfulness of the procedure.
MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICC) were calculated for intrarater and inter-rater reliability. Kappa coefficients for individual items and mean kappa coefficients for all items combined were calculated. Construct validity was assessed with one-way analysis of variance using the hypothesis that experienced clinicians score higher than less experienced clinicians. The approximate time to score one intubation and the instrument's applicability in another setting were evaluated.
RESULTS: ICCs for intrarater and inter-rater reliability were 0.99 (95% CI 0.98 to 0.99) and 0.89 (95% CI 0.35 to 0.96), and mean kappa coefficients were 0.93 (95% CI 0.85 to 1.01) and 0.71 (95% CI 0.56 to 0.92), respectively. There were no differences between the more and less experienced clinicians regarding preparation, performance, communication and total scores. The experienced group scored higher only on tube position/fixation (p=0.02). Scoring one intubation took approximately 15 min. Our instrument, developed in The Netherlands, could be readily applied in the USA.
CONCLUSIONS: Our scoring instrument for simulated neonatal intubations appears to be reliable, feasible and applicable in another centre. Construct validity could not be established.
PMID: 30504442 [PubMed - indexed for MEDLINE]