首页> 美国卫生研究院文献>Paediatrics Child Health >PRACTICE VARIABILITIES DURING PRETERM NEONATAL RESUSCITATION BY THE DEDICATED RESUSCITATION STABILIZATION TEAM
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PRACTICE VARIABILITIES DURING PRETERM NEONATAL RESUSCITATION BY THE DEDICATED RESUSCITATION STABILIZATION TEAM

机译:专用复苏稳定团队进行早搏新生儿复苏期间的实践变异

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摘要

>OBJECTIVES: To evaluate the current practice variabilities during resuscitation of preterm infants by the dedicated Resuscitation Stabilization Team (RST) using videos and respiratory function recordings of the delivery room management. >DESIGN/METHODS: At our center, neonatal stabilization rooms are equipped with video recording and respiratory function monitor. We analyzed the first 10 minutes of delivery room stabilization of preterm infants at birth. The RST performance was evaluated and compared against the Canadian and regional Neonatal Resuscitation Guidelines. >RESULTS: Thirty infants were video recorded over 8 months, with mean gestational age (GA) 26 (±2) weeks and birth weight 960 (±315)g. There was 100% compliance with using the plastic drape for infants less than 28 weeks GA. EKG leads and Pulse Oximetry were applied to all 30 patients. The median time[IQR] for application of the pulse oximetry was 47 seconds [35- 65] from the time of arrival at the table. Only 9/30 infants were suctioned prior to starting the respiratory support. There were inconsistencies in drying and stimulation within first minute for infants less than 28 weeks GA. There was a trend of initiating mask Continuous Positive Airway Pressure (CPAP) prior to completing initial assessment for adequacy of spontaneous breathing. 14 infants were apneic when placed on the table. The median [IQR] time to initiate positive pressure ventilation (PPV) in these apneic babies was 26 seconds [12-37.5]. 5/9 apneic babies didn’t have clinical assessment of heart rate as a part of initial assessment or to establish effectiveness of the ventilation. There were 10 events in 7 patients where PPV was interrupted by the PPV provider for purposes other than ventilation corrective steps. Early initiation of nasal CPAP i.e., less than 10 minutes was noted in 8 babies. >CONCLUSION: The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.
机译:>目的:由专门的复苏稳定小组(RST)使用分娩室管理的视频和呼吸功能记录,评估早产婴儿复苏过程中的当前实践差异。 >设计/方法::在我们的中心,新生儿稳定室配备了视频记录和呼吸功能监控器。我们分析了早产儿出生时头10分钟的稳定情况。对RST的表现进行了评估,并与加拿大和地区的《新生儿复苏指南》进行了比较。 >结果:30个婴儿的视频记录超过8个月,平均胎龄(GA)为26(±2)周,出生体重为960(±315)g。对于GA不足28周的婴儿,使用塑料悬垂窗帘的服从率为100%。将EKG导联和脉搏血氧仪用于所有30例患者。自到达表的时间起,应用脉搏血氧仪的中位时间[IQR]为47秒[35-65]。在开始呼吸支持之前仅吸取9/30婴儿。 GA不足28周的婴儿在第一分钟内的干燥和刺激不一致。在完成对自发呼吸是否足够的初步评估之前,有开始使用面罩持续气道正压(CPAP)的趋势。 14位放在桌子上的婴儿出现呼吸暂停。在这些呼吸暂停婴儿中,开始正压通气(PPV)的中位[IQR]时间为26秒[12-37.5]。 5/9呼吸暂停的婴儿没有进行心率的临床评估,这是初始评估或确定通气效果的一部分。 7例患者中有10例事件,PPV提供商出于通气纠正步骤以外的其他目的中断了PPV。鼻部CPAP的提早开始,即8名婴儿少于10分钟。 >结论:RST性能的结果可与现有文献相媲美。结果代表了一支训练有素的稳定团队有效的新生儿稳定措施。完成复苏的每个步骤的顺序差异可能表明复苏者对个人技能的训练和经验,或者对迅速变化的临床情况的判断。有必要进行持续的复苏培训,特别是对态势感知的培训,以使NRP提供者为及时制定战略计划做好准备。复苏视频可以成为NRP提供者教育和培训的有用工具.RST表现的结果可与现有文献相媲美。结果代表了一支训练有素的稳定团队有效的新生儿稳定措施。完成复苏的每个步骤的顺序差异可能表明复苏者对个人技能的训练和经验,或者对迅速变化的临床情况的判断。有必要进行持续的复苏培训,特别是对态势感知的培训,以使NRP提供者为及时制定战略计划做好准备。复苏视频可以成为NRP提供者教育和培训的有用工具.RST表现的结果可与现有文献相媲美。结果代表了一支训练有素的稳定团队有效的新生儿稳定措施。完成复苏的每个步骤的顺序差异可能表明复苏者对个人技能的训练和经验,或者对迅速变化的临床情况的判断。有必要进行持续的复苏培训,特别是对态势感知的培训,以使NRP提供者为及时制定战略计划做好准备。复苏视频可以成为NRP提供者的教育和培训的有用工具。

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