Ziel des Research Check ist es, Euch regelmässige Updates zu neuen und interessanten Forschungsthemen aus dem Bereich Simulation, Debriefing, Teamzusammenarbeit und Patientensicherheit zu geben und diese zu kommentieren.

Research Check 01/19

Use of neonatal simulation models to assess competency in bag-mask ventilation

SA Pearlman1,2, SC Zern3, T Blackson4, JA Ciarlo4, AB Mackley1,2 and RG Locke1,2

OBJECTIVE:
Providing adequate bag-mask ventilation (BMV) is an essential skill for neonatal resuscitation. Often this skill is learned using simulation manikins. Currently, there is no means of measuring the adequacy of ventilation in simulated scenarios. Thus, it is not possible to ascertain proficiency. The first aim of this study was to measure the pressure generated during BMV as performed by providers with different skill levels and measure the impact of different feedback mechanisms. The second aim was to measure the pressure volume characteristics of two neonatal manikins to see how closely they reflect newborn lung mechanics.

STUDY DESIGN:
In Phase I to achieve the first aim, we evaluated BMV skills in different level providers including residents (n = 5), fellows (n = 5), neonatal nurse practitioners (n = 5) and neonatologists (n = 5). Each provider was required to provide BMV for 2-min epochs on the SimNewB (Laerdal), which had been instrumented to measure pressure-volume characteristics. In sequential 2-min epochs, providers were given different feedback including chest-wall movement alone compared to manometer plus chest-wall movement or chest-wall movement plus manometer plus laptop lung volume depiction. In Phase II of the study we measured pressure-volume characteristics in instrumented versions of the SimNewB (Laerdal) and NeoNatalie (Laerdal).

RESULTS:
In Phase I, all providers are compared with the neonatologists. All measurements of tidal volume (Vt) are below the desired 5 ml kg − 1. The greatest difference in Vt between the neonatologists and other providers occurs when only chest-wall movement is provided. A linear relationship is noted between Vt and PIP for both SimNewB and NeoNatalie. The compliance curves are not ‘S-shaped’ and are different between the two models (P=0.001).

CONCLUSION:
Phase I of this study demonstrates that the SimNewB with the feedback of chest-wall movement alone was the best method of distinguishing experienced from inexperienced providers during simulated BMV. Therefore this is likely to be the best method to ascertain proficiency. Phase II of the study shows that the currently available neonatal simulation manikins do not have pressure-volume characteristics that are reflective of newborn lung mechanics, which can result in suboptimal training.

Journal of Perinatology (2016) 36, 242–246; doi:10.1038/jp.2015.175; published online 19 November 2015

Kurzcharakteristik:

Die Autoren untersuchen ob es möglich ist mit Simulatoren(z.B. SimBaby) die Beutel- Maskenbeatmung effektiv in Verbindung mit verschiedenen Feedbackmechanismen zu trainieren. Zusätzlich wurde noch untersucht ob Simulatoren eine realistische Maskenbeatmung bzgl. Druck und Volumen simulieren können.

Untersucht wurde Anhand von vier verschiedenen Gruppen mit unterschiedlicher Erfahrung, Neonatologe, Assistenzarzt, Student und neonatologische Pflege. Zusätzlich wurde während der Untersuchung mehrfach der Feedbackmechanismus verändert, Brustkorbbewegung, Ventilationsdruckmessung und Volumenmessung. Die gemessenen Werte wurden mit denen der Neonatologen als Referenz verglichen. Das Ergebnis zeigte die signifikantesten Unterschiede, wenn nur die Brustkorbbewegung als Feedbackmechanismus zur Verfügung stand.

Beide Modelle welche für die Untersuchung verwendet wurden zeigten keine typische S-Kurve während der Ventilation. Zusätzlich benötigte man für die Applikation gleicher Volumina stark differierende Drücke(~10:35 cmH2O), was zeigt dass sich Simulatonspuppen nur bedingt zum Masken-Beutel Training eignen. (geschrieben von Thomas Marte)