Work

Optimizing oxygen delivery for neonatal resuscitation through self-inflating bags in settings without air-oxygen blenders

Year: 2025

Type: article

Abstract: Background Resuscitation guidelines recommend fractional inspired oxygen (FiO 2 ) of 0.21–0.30 for infants at <35 weeks gestation. However, without an air-oxygen blender, an FiO 2 < 0.3 is difficult to achieve with a self-inflating resuscitation bag (SIRB). This study investigated the effects of adjustments to the oxygen flow rate (FR), peak inspiratory pressure (PIP), and ventilation rate (VR) on FiO 2 levels with SIRBs. Methods Two nondisposable SIRBs were used: a 280 mL bag (40 cm H 2 O pop-off valve) and a 62 mL bag with a reservoir tube (25 and 40 cm H 2 O pop-off valve). Both SIRBs were supplied with 100% oxygen and connected to a flow meter, pressure gauge, oxygen analyzer, and test lung. FR (0.5, 1, 2, 5, or 10 L/min), PIP (20–29, 30–39, or ≥ 40 cm H 2 O), and VR (40, 50, or 60/min) parameters were tested sequentially. FiO 2 was measured every 30 s for 150 s total, and each parameter combination was evaluated three times. Data were analyzed with a stepwise generalized linear model. Results FiO 2 levels stabilized after 60–90 s of bagging across all settings, ranging from 0.27–0.82 and 0.40–1.0 for the 280 and 62 mL SIRBs, respectively. A higher FR increased FiO 2 levels, whereas a higher PIP decreased FiO 2 levels. VR increases did not affect FiO 2 except at an FR ≥ 5 L/min. An FiO 2 < 0.30 was achievable only with the 280 mL SIRB at 0.5 L/min FR and PIP > 40 cm H 2 O. FR had the greatest effect (R 2 = 0.4916) on FiO 2 . SIRB, PIP, VR, and bagging duration further improved the model's predictive power (R 2 = 0.9578). Conclusions A suitable SIRB, FR, PIP, and VR are crucial for FiO 2 titration in resuscitation. Further validation of these findings in clinical studies is warranted.

Source: Pediatrics & Neonatology

DOI: 10.1016/j.pedneo.2025.05.007

Authors: Tzu-Ching Sung, Hsiang-Chin Hsu, Yun-Ju Chen, Yuh-Jyh Lin, Chyi-Her Lin

Institutions: I-Shou University, National Cheng Kung University Hospital, National Cheng Kung University

Language: English

Topic: Neonatal Respiratory Health Research

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: E-Da Hospital