Telecoaching Improves Positive Pressure Ventilation Performance During Simulated Neonatal Resuscitations.

Abstract

Introduction: Positive pressure ventilation (PPV) is a critical skill for neonatal resuscitation. We hypothesized that telecoaching would improve PPV performance in neonatal providers during simulated neonatal resuscitations.

Setting: Level IV neonatal intensive care unit (NICU).

Methods: This prospective crossover study included 14 experienced NICU nurses and respiratory therapists who performed PPV on a mannequin that recorded parameters of ventilation efficiency. Participants were randomized to practice independently (control) or with live feedback from a remote facilitator through audiovisual connection (intervention) and then switched to the opposite group. Participants' mask leak percentage, ventilation rates, and pressure delivery were analyzed.

Results: The primary outcome of mask leak percentage was significantly increased in the telecoaching group (19% [interquartile range {IQR} 14-59.25] vs. 100% [IQR 88-100] leak, p = 0.0001). The secondary outcome of peak inspiratory pressure (PIP) delivery was also increased (median 27.6 [IQR 23.5-34.7] vs. 23.3 [IQR 19.1-32.8] cmH₂O, p < 0.001). Differences in ventilation rates were not statistically significant (55 vs. 58 breaths/min, p = 0.51).

Conclusion: Participants demonstrated better PPV performance during telecoaching with less mask leak. The intervention group also had higher measured peak inspiratory pressures. Telecoaching may be a feasible method to provide real-time feedback to health care providers during simulated neonatal resuscitations.

Hypothesis: Neonatal providers who receive telecoaching during simulated resuscitations will perform PPV more effectively than those who do not receive telecoaching.