Effectiveness and acceptability of bag-and-mask ventilation with visual monitor for improving neonatal resuscitation in simulated setting in six hospitals of Nepal
Abstract
Aim: The first minute or the “Golden MinuteSM” is crucial to save 10 million newborns who do not breathe at birth through effective newborn resuscitation. Improving the performance of health workers on neonatal resuscitation will be critical to ensure that the babies are effectively ventilated. We conducted a study to evaluate whether a bag-and-mask ventilation with monitor is effective in improving neonatal resuscitation practice in a simulated setting.
Methods: This is a cross-over design conducted in 6 public hospitals with 82 health workers of Nepal nested over the large scale stepped wedged quality improvement project. A standard one-day training on neonatal resuscitation was conducted. At the end of the training, participants were evaluated on the bag-and-mask ventilation performance in a manikin. Neonatal resuscitation performance was evaluated based on the tidal volume, positive end expiratory pressure and air leakage from the mask displayed in the monitor. The evaluation was done in two sessions of neonatal resuscitation performance in the manikin. In one session with the monitor displayed to health workers and other session without the monitor displayed to health worker. The comparison of the neonatal resuscitation performance with and without monitor displayed is calculated. We also conducted assessment of confidence with or without monitor of the health workers.
Result: Adequacy of ventilation using bag-and-mask was improved when the health workers were displayed monitor (90%) vs without monitor (76%) (p<0.01). The air leakage from the mask reduced when the monitor was displayed (12%) vs without (30%). The PPEP improved when the health workers used monitor as guide to conduct neonatal resuscitation in the manikin then without monitor displayed. The participants felt confident performing ventilations during the visible sessions.
Conclusion: The ventilation function monitor helped participants to improve their ventilation skills through real-time feedback of important ventilation parameters. Ventilation monitor provide rapid feedback on neonatal resuscitation performance to make effective ventilation. Clinical evaluation of the bag-and-mask with monitor displaying ventilation needs to be done to assess the effectiveness of the device.
