Ramesh Kumar, T (2013) Positive Pressure Ventilation During Neonatal Resuscitation in Neonates > 34 Wks Gestation ; Efficacy Of LMA Vs Face Mask : A Randomized Controlled Trial. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : The American Academy of Paediatrics has formulated the Neonatal resuscitation guidelines and published it on 2010 and suggested modification based on local needs[1]. These guidelines recommend changes in resuscitation practices from the previous guidelines formed at 2005 based on evidences rather than experience. These guidelines primarily apply to neonates undergoing transition from intrauterine to extra uterine life with difficulty. About 10% of the neonates require some form of resuscitation and less than 1% requires extensive resuscitation [2]. Ventilation of the lungs is the important step for successful resuscitation. Ineffective ventilation can lead to prolonged or unsuccessful resuscitation. Successful resuscitation needs proper anticipation, adequate preparation, accurate evaluation and prompt initiation. The first 1 minute of neonatal resuscitation is called as golden minute wherein active steps are taken to ventilate the lungs. Each step in resuscitation is performed for 30 seconds with assessment of heart rate, respiration and saturation at the end of every step. The decision to administer positive pressure ventilation is taken at the end of 30 seconds of starting resuscitation when the neonate is apneic or gasping or with heart rate less than 100/min. Ventilative corrective steps may be done if there is failure to rise in heart rate after initial few seconds of positive pressure ventilation. The ventilation corrective steps include mask adjustment, repositioning of baby, suctioning of oral cavity, pressure increase and usage of alternate airway like laryngeal mask airway (LMA). AIMS AND OBJECTIVES : To compare the efficacy of LMA versus Face mask ventilation in reducing the need for endotracheal intubation during neonatal resuscitation. CONCLUSION : The role of LMA in neonatal resuscitation when compared to facemask is efficacious and statistically significant. LMA quickly restores the heart rate to more than 100 when compared to face mask. Average time taken to insert LMA is less than 3 seconds even when done by paediatric residents with training. Hence use of LMA is not associated with any delay in initiation of resuscitation. The mean duration of PPV by LMA is comparable to facemask. LMA may be applied in situations where prolonged PPV is needed as a substitute to face mask ventilation. Further studies in the use of LMA in neonatal resuscitation are required for recommending changes in clinical practice. LMA is a safe and more effective alternative to face mask in neonatal resuscitation.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Positive Pressure Ventilation ; Neonatal Resuscitation ; Neonates > 34 Wks Gestation ; Efficacy Of LMA ; Face Mask ; Randomized Controlled Trial. |
| Subjects: | MEDICAL > Neonatology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 14 Jul 2017 06:49 |
| Last Modified: | 14 Jul 2017 06:49 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1644 |
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