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Wednesday, February 3, 2010

It's time to get rid of neonatal AMBU-bags

It's hard to change old habits, but new studies show that it's time to get rid of those neonatal Ambu-bags. While we still have Ambu-bags hanging on the walls over the Incubators, they are now seldom used in leu of using the Neo-Puff.

When we first got our Neo-puff I thought it was a waste of money. "Why can't we just bag?" was my initial response.

Another complaint of the Neo-puff is you cannot feel resistance, or changes in compliance, as you can while bagging. One doctor actually said when he used the Neo-puff it felt as though he wasn't even giving a breath, so he stopped using it.

However, that was before I learned how easy this machine was, and before I read the latest studies.

Neo-puff is a brand name, so most books refer to them as t-piece resuscitators. They are easy to use because they have an oxygen blender in them so you can set the FiO2 at 40% and adjust for whatever range you desire. You set the peak inspiratory pressure and PEEP, and that's it. All you have to do to ventilate the baby is to use your thumb to block the PEEP valve.

The greatest advantage is not for the caregiver, but for the patient. With the Ambu-bag the pressure generated to give a breath is based on your squeeze of the bag. If you aren't paying attention, you may give too much pressure and cause barotrauma. This cannot happen with a properly used Neo-puff.

Another advantage is that studies show that with the use of Neo-puff the cases of Hyline membrane disease has greatly decreased. Evidence shows that inconsistent pressures from the Ambu-bag actually cause bruising in the neonate airway, and this can result in further complications for the newborn, making them extremely difficult to treat.

The Neo-puff, on the other hand, gives constant, gentle pressure that are much easier on the infants gentle airways.

The following are the recommendations for setting up a Neo-puff:

  1. 1. Set PIP at 20-25 (just enough to get adequate chest rise)

  2. Set PEEP 3-5

  3. Set pop off @ 30 CWP (20-24 for premature infants)

  4. Set FiO2 at 40%

  5. The rate should be 40-60 (determined by finger of medical worker)

Another neat thing about the Neo-puff is it can be used to deliver CPAP is the baby is spontaneously breathing with labored breaths. And, if your hospital uses Neonatal Resuscitation Program guidelines, you do not need a doctor's order to use it. You can use it as CPAP simply by holding the mask over the neonates nose and mouth.

Of course, another advantage of a neopuff is it is easy to operate, and it takes a lot longer to wear out the operator, as opposed to bagging.


emt.dan said...

Very Interesting, thank you for posting. Is this product designed only to be used in hospital NICUs, or could it be brought to the field, either for premature births NICU transports?

Jeff said...

Not sure what Neopuff you are refrring to that has a "oxygen blender in them"...Neopuff units do not have a built in oxygen blender.

Rick Frea said...

I imagine the Neopuff doesn't come with the blender, but it's recommended you add one to it.This is the one we use. The Neonatal Resuscitation Program highly recommends not using greater than 40 percent FiO2 on neonates. Some newer studies recomend 21% Fio2.  However, it's better to have a neopuff with no blender than no neopuff at all.