The Self-Inflating Resuscitation Bag Delivers High Oxygen Concentrations When Used Without a Reservoir: Implications for Neonatal Resuscitation

OBJECTIVE: To measure the delivered fractional oxygen concentration (F_DO2) from preterm-size Laerdal silicone resuscitators (PLSR) without a reservoir.

BACKGROUND: The North American Neonatal Resuscitation Program manual states that self-inflating bags without a reservoir deliver approximately 40% oxygen, differing from the PLSR manufacturer's specifications.

METHODS: A neonatal test lung was manually ventilated using PLSRs without a reservoir. A 50 psi 100% oxygen source and an oxygen flow meter were used to provide desired oxygen inlet flows. F_DO2 was measured using 3 different PLSRs after 4 min of manual ventilation of a neonatal test lung, at differing inspired tidal volumes (5 mL or 20 mL), respiratory rates (40 breaths/min or 60 breaths/min), and oxygen inlet flows (1 to 4, 5, and 10 L/min). RESULTS: In all tests using 5 or 10 L/min, F_DO2 exceeded 0.95. The lowest F_DO2 was 0.59, at 1 L/min.

CONCLUSIONS: The F_DO2 measured during this study did not differ from PLSR specifications. The F_DO2 did, however, differ from information contained in the North American Neonatal Resuscitation Program manual regarding use of a self-inflating bag without a reservoir. Care should be taken when selecting a self-inflating resuscitation device to provide blended air and oxygen, as high concentrations of oxygen may be delivered by these devices even when the reservoir is removed. American and Canadian recommendations for the provision of supplemental oxygen with self-inflating bags require reevaluation.