Positive pressure hand ventilation: potential errors in estimating inflation pressures

Despite increasing electronic sophistication in the design of mechanical ventilators, there has been persistent dependence on hand bagging in acute neonatal respiratory failure. Hand ventilation continues to be clinically useful in preparation for the application of the mechanical ventilator and to support airway suctioning.1 High inflation peak pressures can lead to the development of pulmonary air leaks; therefore, the use of a pressure manometer with neonatal hand bag ventilation equipment is widely recommended.2,3 Although no manufacturer currently markets a pressure manometer designed exclusively for use with neonatal hand ventilation equipment, many neonatal intensive care centers currently use diaphragm-type manometers for this purpose.