{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T02:01:13Z","timestamp":1773280873803,"version":"3.50.1"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,3,1]]},"abstract":"<jats:p>Objective. The standard technique for positive-pressure ventilation is to regulate the breath size by varying the pressure applied to the bag. Investigators have argued that consistency of peak inspiratory pressure is important. However, research shows that excessive tidal volume delivered with excessive pressure injures preterm lungs, which suggests that inspiratory pressure should be varied during times of changing compliance, such as resuscitation of newborns or treatment after surfactant delivery.<\/jats:p>\n               <jats:p>Methods. We modified a computerized lung model (ASL5000 [IngMar Medical, Pittsburgh, PA]) to simulate the functional residual capacity of a 3-kg neonate with apnea and programmed it to change compliance during ventilation. Forty-five professionals were blinded to randomized compliance changes while using a flow-inflating bag, a self-inflating bag, and a T-piece resuscitator. We instructed subjects to maintain a constant inflation volume, first while blinded to delivered volume and then with volume displayed, with all 3 devices.<\/jats:p>\n               <jats:p>Results. Subjects adapted to compliance changes by adjusting inflation pressure more effectively when delivered volume was displayed. When only pressure was displayed, sensing of compliance changes occurred only with the self-inflating bag. When volume was displayed, adjustments to compliance changes occurred with all 3 devices, although the self-inflating bag was superior.<\/jats:p>\n               <jats:p>Conclusions. In this lung model, volume display permitted far better detection of compliance changes compared with display of only pressure. Devices for administration of positive-pressure ventilation should display volume rather than pressure.<\/jats:p>","DOI":"10.1542\/peds.2008-2012","type":"journal-article","created":{"date-parts":[[2009,2,3]],"date-time":"2009-02-03T01:34:18Z","timestamp":1233624858000},"page":"e465-e470","source":"Crossref","is-referenced-by-count":74,"title":["Responding to Compliance Changes in a Lung Model During Manual Ventilation: Perhaps Volume, Rather Than Pressure, Should be Displayed"],"prefix":"10.1542","volume":"123","author":[{"given":"John","family":"Kattwinkel","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corrine","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Gurka","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology"},{"name":"Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alix","family":"Paget-Brown","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2009,3,1]]},"reference":[{"key":"2021120902495738100_R1","unstructured":"Kattwinkel J, ed. Textbook of Neonatal Resuscitation. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006"},{"key":"2021120902495738100_R2","unstructured":"Avery ME, Fletcher BD. The Lung and Its Disorders in the Newborn Infant. Philadelphia, PA: Saunders; 1974"},{"key":"2021120902495738100_R3","doi-asserted-by":"crossref","unstructured":"Bjo\u0308rklund LJ, Ingimarsson J, Curstedt T, Larsson A, Robertson B, Werner O. Lung recruitment at birth does not improve lung function in immature lambs receiving surfactant. Acta Anaesthesiol Scand.\u20082001;45(8):986\u2013993","DOI":"10.1034\/j.1399-6576.2001.450811.x"},{"key":"2021120902495738100_R4","doi-asserted-by":"crossref","unstructured":"Hillman NH, Moss TJ, Kallapur SG, et al. Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep. Am J Respir Crit Care Med.\u20082007;176(6):575\u2013581","DOI":"10.1164\/rccm.200701-051OC"},{"key":"2021120902495738100_R5","doi-asserted-by":"crossref","unstructured":"International Liaison Committee on Resuscitation. International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation. Pediatrics.\u20082006;117(5). Available at: www.pediatrics.org\/cgi\/content\/full\/117\/5\/e978","DOI":"10.1542\/peds.2006-0350"},{"key":"2021120902495738100_R6","doi-asserted-by":"crossref","unstructured":"Hird MF, Greenough A, Gamsu HR. Inflating pressures for effective resuscitation of preterm infants. Early Hum Dev.\u20081991;26(1):69\u201372","DOI":"10.1016\/0378-3782(91)90045-5"},{"key":"2021120902495738100_R7","doi-asserted-by":"crossref","unstructured":"Lindner W, Vossbeck S, Hummler H, Pohlandt F. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation?Pediatrics.\u20081999;103(5):961\u2013967","DOI":"10.1542\/peds.103.5.961"},{"key":"2021120902495738100_R8","doi-asserted-by":"crossref","unstructured":"Finer NN, Rich W, Craft A, Henderson C. Comparison of methods of bag and mask ventilation for neonatal resuscitation. Resuscitation.\u20082001;49(3):299\u2013305","DOI":"10.1016\/S0300-9572(01)00311-2"},{"key":"2021120902495738100_R9","doi-asserted-by":"crossref","unstructured":"O'Donnell CP, Davis PG, Lau R, Dargaville PA, Doyle LW, Morley CJ. Neonatal resuscitation 2: an evaluation of manual ventilation devices and face masks. Arch Dis Child Fetal Neonatal Ed.\u20082005;90(5):F392\u2013F396","DOI":"10.1136\/adc.2004.064691"},{"key":"2021120902495738100_R10","doi-asserted-by":"crossref","unstructured":"Oddie S, Wyllie J, Scally A. Use of self-inflating bags for neonatal resuscitation. Resuscitation.\u20082005;67(1):109\u2013112","DOI":"10.1016\/j.resuscitation.2005.05.004"},{"key":"2021120902495738100_R11","doi-asserted-by":"crossref","unstructured":"Hernandez LA, Peevy KJ, Moise AA, Parker JC. Chest wall restriction limits high airway pressure-induced lung injury in young rabbits. J Appl Physiol.\u20081989;66(5):2364\u20132368","DOI":"10.1152\/jappl.1989.66.5.2364"},{"key":"2021120902495738100_R12","doi-asserted-by":"crossref","unstructured":"Karlberg P, Koch G. Respiratory studies in newborn infants, part III: development of mechanics of breathing during the first week of life: a longitudinal study. Acta Paediatr Suppl.\u20081962;135:121\u2013129","DOI":"10.1111\/j.1651-2227.1962.tb08666.x"},{"key":"2021120902495738100_R13","doi-asserted-by":"crossref","unstructured":"Davis JM, Veness-Meehan K, Notter RH, Bhutan VK, Kendig JW, Shapiro DL. Changes in pulmonary mechanics after the administration of surfactant to infants with respiratory distress syndrome. N Engl J Med.\u20081988;319(8):476\u2013479","DOI":"10.1056\/NEJM198808253190804"},{"key":"2021120902495738100_R14","doi-asserted-by":"crossref","unstructured":"Kelly E, Bryan H, Possmayer F, Frndova H, Bryan C. Compliance of the respiratory system in newborn infants pre- and postsurfactant replacement therapy. Pediatr Pulmonol.\u20081993;15(4):225\u2013230","DOI":"10.1002\/ppul.1950150408"},{"key":"2021120902495738100_R15","doi-asserted-by":"crossref","unstructured":"Berglund G, Karlberg P. Determination of the functional residual capacity in newborn infants: preliminary report. Acta Paediatr.\u20081956;45(5):541\u2013544","DOI":"10.1111\/j.1651-2227.1956.tb06913.x"},{"key":"2021120902495738100_R16","doi-asserted-by":"crossref","unstructured":"Verbeke G, Molenberghs G. Linear Mixed Models for Longitudinal Data. New York, NY: Springer; 2000","DOI":"10.1007\/978-1-4419-0300-6"},{"key":"2021120902495738100_R17","doi-asserted-by":"crossref","unstructured":"Hazinski MF, Nolan JP, Becker LB, Steen PA. Controversial topics from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation.\u20082005;112(suppl I):III-133\u2013III-136","DOI":"10.1161\/CIRCULATIONAHA.105.170814"},{"key":"2021120902495738100_R18","doi-asserted-by":"crossref","unstructured":"Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room: associated clinical events. Arch Pediatr Adolesc Med.\u20081995;149(1):20\u201325","DOI":"10.1001\/archpedi.1995.02170130022005"},{"key":"2021120902495738100_R19","doi-asserted-by":"crossref","unstructured":"Upton CJ, Milner AD. Endotracheal resuscitation of neonates using a rebreathing bag. Arch Dis Child.\u20081991;66(1 spec No.):39\u201342","DOI":"10.1136\/adc.66.1_Spec_No.39"},{"key":"2021120902495738100_R20","doi-asserted-by":"crossref","unstructured":"Spears RS, Yeh A, Fisher DM, Zwass MS. The \u201ceducated hand\u201d: can anesthesiologists assess changes in neonatal pulmonary compliance manually?Anesthesiology.\u20081991;75(4):693\u2013696","DOI":"10.1097\/00000542-199110000-00022"},{"key":"2021120902495738100_R21","doi-asserted-by":"crossref","unstructured":"Schily M, Koumoukelis H, Lerman J, Creighton RE. Can pediatric anesthesiologists detect an occluded tracheal tube in neonates?Anesth Analg.\u20082001;93(1):66\u201370","DOI":"10.1097\/00000539-200107000-00015"},{"key":"2021120902495738100_R22","doi-asserted-by":"crossref","unstructured":"Karlberg P, Cherry RB, Escardo FE, Koch G. Respiratory studies in newborn infants, part 2: pulmonary ventilation and mechanics of breathing in the first minutes of life, including the onset of respiration. Acta Paediatr.\u20081962;51(2):121\u2013136","DOI":"10.1111\/j.1651-2227.1962.tb06521.x"},{"key":"2021120902495738100_R23","unstructured":"Smith C, Nelson N, eds. The Physiology of the Newborn Infant. 4th ed. Springfield, IL: Charles C. Thomas; 1976:209"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/123\/3\/e465\/1067650\/zpe0030900e465.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/123\/3\/e465\/1067650\/zpe0030900e465.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T15:57:00Z","timestamp":1639065420000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/123\/3\/e465\/71721\/Responding-to-Compliance-Changes-in-a-Lung-Model"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,3,1]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2009,3,1]]},"published-print":{"date-parts":[[2009,3,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-2012","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,3,1]]}}}