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Newborn infants who receive positive pressure ventilation for resuscitation, and use of a device to assess respiratory function

Question Type:
Intervention
Full Question:
Newborn infants who receive positive pressure ventilation for resuscitation (P), does Use of a device to assess respiratory function with or without pressure monitoring  (I), compared with No Device (C), change survival to hospital discharge with good neurological outcome, Intraventricular Hemorrhage, time to heart rate > 100 bpm, Bronchopulmonary dysplasia, Pneumothorax (O)?
Consensus on Science:
Flow and Volume MonitoringFor the critical outcome of survival to hospital discharge and IVH, we identified low-quality evidence (downgraded for risk of bias and imprecision) from 1 pilot randomized controlled trial enrolling 49 babies showing no benefit.(Schmolzer 2012, 377)For the critical outcome of time to heart rate greater than 100/min and neurologically intact survival, we found no evidence.For the important outcome of bronchopulmonary dysplasia and pneumothorax, we found no evidence.CapnographyFor the critical outcome of survival to hospital discharge and IVH, we identified low-quality evidence (downgraded for risk of bias and imprecision) from 1 pilot randomized clinical trial enrolling 48 babies showing no evidence. (Kong 2013, 104)For the critical outcome of time to heart rate greater than 100/min and neurologically intact survival, we found no evidence.For the important outcome of bronchopulmonary dysplasia and pneumothorax, we identified low-quality evidence (downgraded for risk of bias and imprecision) from 1 pilot randomized clinical trial enrolling 48 babies showing no evidence.(Kong 2013, 104)
Treatment Recommendation:
Although a feasible technique, we suggest against the routine use of flow and volume monitoring for babies who receive PPV at birth, until more evidence becomes available (weak recommendation, low-quality evidence).Although a feasible technique, we suggest against the routine use of capnography for babies who receive PPV at birth, until more evidence becomes available (weak recommendation, low-quality evidence).Values, Preferences, and Task Force InsightsWe should consider revising future PICO questions to embrace new technologies for more reasonable outcomes and benchmarks rather than death and disability. It was stressed that it is important to point out the human factors piece of the equation. The devices are only as useful as how well the human care provider can interface with and incorporate them appropriately into care. Another point raised is that we have process outcomes, but do they impact actual performance? Do we need this to be a more stepwise approach? What other process outcomes should be included? In the future, we need to look at device design, types of alarms (visual or audio, color, font, etc). If this were a medication, we would suggest against something with such resource implications.
CoSTR Attachments:
Capnography Quality Assessment_n.docx    
Capnography Recommendations_n.docx    
Flow and Volume Monitoring Quality Assessment_n.docx    
Flow and Volume Monitoring Recommendations_n.docx    

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