Question
What is the best available evidence to determine the efficacy and safety of respiratory function monitoring (RFM) (in addition to clinical assessment) compared with clinical assessment alone in reducing mortality and morbidity in newborn infants receiving positive pressure ventilation (PPV)?
Relevance to nursing care
Three to six per cent of all newborn infants in neonatal intensive care units require respiratory resuscitation at birth. PPV is used during resuscitation to establish a functional residual capacity and to deliver an appropriate tidal volume (Vt) to achieve adequate gas exchange.
During this process, clinical judgement such as observing the infant's chest wall movements, heart rate and oxygen saturation has been used to determine the effectiveness of the ventilation. However, in neonatal resuscitation, this practice should be guided by RFM such as airway pressure, gas flow, Vt, peak inflation pressure and positive end expiratory pressure. This is because excessive delivery of Vt could overinflate the neonate lungs causing volutrauma and insufficient Vt could result in inadequate gas exchange during resuscitation. Currently there is insufficient evidence to determine the efficacy and safety of RFM in addition to clinical assessment during PPV at neonatal resuscitation.
Study characteristics
The review focused on locating all randomised, quasirandomised controlled trials and cluster trials that were available as abstracts or peer-reviewed manuscripts.1 Either term or preterm infants who were resuscitated using RFM (in addition to clinical assessment) and compared with term or preterm infants receiving clinical assessment alone were included.
No studies were found addressing the issue of monitoring respiratory function in addition to clinical assessment during neonatal resuscitation.
Summary of key evidence
* The search located no studies that met the inclusion criteria for this review.
* A search of clinical trial registries for ongoing or recently completed studies retrieved one ongoing trial. This study investigates RFM (either visible or covered) during PPV in preterm infants of <=32 weeks of gestation. Each infant who requires PPV at birth has a flow sensor placed between the mask and the Neopuff T-piece device to measure the airflow and calculate the Vt. This study was not included in the review as it is an ongoing trial.
Implications for nursing practice
Currently there is insufficient evidence to determine the efficacy and safety of RFM in addition to clinical assessment during PPV at neonatal resuscitation.
Implications for research
Further well-designed randomised controlled trials are needed to compare PPV with and without a respiratory function monitor in addition to clinical assessment at neonatal resuscitation.
Reference