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Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit.

van Vonderen JJ, van Zanten HA, Schilleman K, Hooper SB, Kitchen MJ, Witlox RS, Te Pas AB - Front Pediatr (2016)

Bottom Line: Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle.These physiological parameters, with or without the combination of video recordings, can not only be used directly to guide care but also be used later for audit and teaching purposes.Further studies are needed to investigate whether this will improve the quality of delivery room management.

View Article: PubMed Central - PubMed

Affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center , Leiden , Netherlands.

ABSTRACT
Neonatal resuscitation is one of the most frequently performed procedures, and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant's condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography, and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can not only be used directly to guide care but also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this narrative review, we will give an update of the current developments in monitoring neonatal resuscitation.

No MeSH data available.


Related in: MedlinePlus

Recording of a preterm infant receiving positive pressure ventilation. The tracing shows pressure (red), flow (green), expiratory volume (blue), and pulse rate (red). The blue arrow points a part of the volume entering the oropharynx at the start of the inflation. The green arrow points at the part of volume entering the lungs when the pressure time integral is large enough to overcome the resistance of the glottis and upper airway.
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Figure 1: Recording of a preterm infant receiving positive pressure ventilation. The tracing shows pressure (red), flow (green), expiratory volume (blue), and pulse rate (red). The blue arrow points a part of the volume entering the oropharynx at the start of the inflation. The green arrow points at the part of volume entering the lungs when the pressure time integral is large enough to overcome the resistance of the glottis and upper airway.

Mentions: During mask ventilation, the complete respiratory tract (nasopharynx, trachea, and lungs) is pressurized and ventilated. During inflations, there is volume displacement of the nasopharynx, which does not occur during spontaneous breathing (67). This could even lead to VT measurements during ventilation against a closed larynx (Figure 1). During fetal development, laryngeal adduction maintains a higher intra-pulmonary pressure, essential for lung development (68, 69). It is likely that the larynx remains mostly closed at birth, only opened briefly during a breath, which prevents face mask ventilation from inflating the lung (2, 70, 71).


Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit.

van Vonderen JJ, van Zanten HA, Schilleman K, Hooper SB, Kitchen MJ, Witlox RS, Te Pas AB - Front Pediatr (2016)

Recording of a preterm infant receiving positive pressure ventilation. The tracing shows pressure (red), flow (green), expiratory volume (blue), and pulse rate (red). The blue arrow points a part of the volume entering the oropharynx at the start of the inflation. The green arrow points at the part of volume entering the lungs when the pressure time integral is large enough to overcome the resistance of the glottis and upper airway.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834521&req=5

Figure 1: Recording of a preterm infant receiving positive pressure ventilation. The tracing shows pressure (red), flow (green), expiratory volume (blue), and pulse rate (red). The blue arrow points a part of the volume entering the oropharynx at the start of the inflation. The green arrow points at the part of volume entering the lungs when the pressure time integral is large enough to overcome the resistance of the glottis and upper airway.
Mentions: During mask ventilation, the complete respiratory tract (nasopharynx, trachea, and lungs) is pressurized and ventilated. During inflations, there is volume displacement of the nasopharynx, which does not occur during spontaneous breathing (67). This could even lead to VT measurements during ventilation against a closed larynx (Figure 1). During fetal development, laryngeal adduction maintains a higher intra-pulmonary pressure, essential for lung development (68, 69). It is likely that the larynx remains mostly closed at birth, only opened briefly during a breath, which prevents face mask ventilation from inflating the lung (2, 70, 71).

Bottom Line: Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle.These physiological parameters, with or without the combination of video recordings, can not only be used directly to guide care but also be used later for audit and teaching purposes.Further studies are needed to investigate whether this will improve the quality of delivery room management.

View Article: PubMed Central - PubMed

Affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center , Leiden , Netherlands.

ABSTRACT
Neonatal resuscitation is one of the most frequently performed procedures, and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant's condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography, and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can not only be used directly to guide care but also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this narrative review, we will give an update of the current developments in monitoring neonatal resuscitation.

No MeSH data available.


Related in: MedlinePlus