1377 Effects of prolonged and slow-rise inflation pressures on resuscitation of asphyxiated newborn babies

Abstract

Previous studies have shown that resuscitation using standard techniques produces a much smaller tidal volume compared to the spontaneously breathing baby, and rarely leads to the formation of a functional residual capacity (FRC). Construction of inflation pressure/tidal volume loops suggested that there were always opening pressures: again very different from the pattern seen in spontaneously breathing babies. Inspection of traces indicated that the lung volume had not stabilised after one second's inflation. We have therefore resuscitated a further group of babies, five born by Caesarean section and four by vaginal delivery, maintaining the initial inflation for a mean of five seconds. This effectively doubled the inflation volume compared to the previous study (from 18.6ml, range 0 - 62.5ml; to 33.6ml, range 16.9 - 70ml). On all occasions this led to the formation of an FRC (mean 15.9ml, range 11.7 - 23.2ml). On five occasions inflation pressure was raised slowly over 2 - 3 seconds. Air started to enter the lungs as soon as inflation commenced in four of the five babies. Our conclusions are:

1) that prolonged initial inflation will lead to better lung expansion;

2) the apparent opening pressures seen in the previous study were not due to surface tension forces in the lung.

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