Airway Obstruction During Mask Ventilation of Very Low Birth Weight Infants During Neonatal Resuscitation

Finer, Neil N.; Rich, Wade; Wang, Casey; Leone, Tina A.

doi:10.1542/peds.2008-0560

Cited by 166 publications

(126 citation statements)

References 15 publications

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“…55 We have found that over 80% of such infants receiving bag and mask breaths have evidence of airway obstruction during the initial breaths and that such airway obstruction may persist for 37 or more breaths over a period of a minute or longer. 56 These obstructed breaths may often go unrecognized in the absence of a CO 2 detection device and may lead to bradycardia and hypoxia, and, in time, to further, more aggressive and hazardous procedures, such as increased pressure compressions, intubation or medications, if not rapidly recognized and relieved.…”

Section: Bag and Mask Ventilationmentioning

confidence: 99%

Neonatal resuscitation for the preterm infant: evidence versus practice

Finer

Rich

2010

J Perinatol

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In an effort to determine the actual conduct of neonatal resuscitation and the errors that may be occurring during this process, we developed a method of video recording neonatal resuscitations as an ongoing quality assurance project. We initiated video recordings of resuscitations using simple video recorders attached to an overhead warmer and reviewed the resultant tapes during biweekly quality improvement meetings. We also added the continuous recording of analog information such as heart rate, oximeter values, fraction of inspired oxygen and airway pressure. We subsequently developed a checklist that includes a preresuscitation briefing and a postresuscitation debriefing, all of which are reviewed at the same time as the video recording. We have examined the use of oxygen in the very preterm infant, the effectiveness of bag and mask ventilation, including the detection of airway obstruction during such ventilation, intubation in the delivery area and environment. In addition, we have trained our teams and leaders using Crew Resource Management and focused on improved communication. The availability of a dedicated room for resuscitation allows an increased ambient environment and the ability to provide a userfriendly setting similar to the neonatal intensive care unit to optimize performance. There are numerous opportunities for improving team and leader performance and outcomes following neonatal resuscitation. Further prospective studies are required to evaluate specific interventions.

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Section: Bag and Mask Ventilationmentioning

confidence: 99%

Neonatal resuscitation for the preterm infant: evidence versus practice

Finer

Rich

2010

J Perinatol

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“…8,9,11 Sometimes, to prevent mask leak, caregivers press too firmly, which can cause obstruction. 26 With the use of a nasal tube, although compressive forces are not involved, leak may occur from the contralateral nostril or as a result of an open mouth and inadequate jaw thrust, …”

Section: Discussionmentioning

confidence: 99%

“…5 However, during the application of manual positive-pressure ventilation (PPV) to infants, leaks around the face mask are common and obstruction of the upper airway may occur, leading to inadequate ventilation. [6][7][8][9][10] Mask leak and obstruction during mask PPV are often not recognized. 8,9,11 They may compromise the delivery of the set positive end-expiratory pressure (PEEP) and appropriate tidal volumes, resulting in delayed establishment of effective gas exchange.…”

mentioning

confidence: 99%

“…[6][7][8][9][10] Mask leak and obstruction during mask PPV are often not recognized. 8,9,11 They may compromise the delivery of the set positive end-expiratory pressure (PEEP) and appropriate tidal volumes, resulting in delayed establishment of effective gas exchange. 8,9 Current guidelines for the stabilization of premature infants in the DR recommend the use of an appropriately sized face mask and the provision of PEEP if available.…”

mentioning

confidence: 99%

“…8,9,11 They may compromise the delivery of the set positive end-expiratory pressure (PEEP) and appropriate tidal volumes, resulting in delayed establishment of effective gas exchange. 8,9 Current guidelines for the stabilization of premature infants in the DR recommend the use of an appropriately sized face mask and the provision of PEEP if available. 2 Most extremely preterm infants cry and breathe immediately after birth 12 and can be successfully stabilized in the DR by using continuous positive airway pressure (CPAP).…”

mentioning

confidence: 99%

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Mask Versus Nasal Tube for Stabilization of Preterm Infants at Birth: A Randomized Controlled Trial

et al. 2013

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OBJECTIVE: Positive-pressure ventilation (PPV) using a manual ventilation device and a face mask is recommended for compromised newborn infants in the delivery room (DR). Mask ventilation is associated with airway obstruction and leak. A nasal tube is an alternative interface, but its safety and efficacy have not been tested in extremely preterm infants. METHODS: An unblinded randomized controlled trial was conducted in Australia, and the Netherlands. Infants were stratified by gestational age (24–25/26–29 weeks) and center. Immediately before birth infants were randomly assigned to receive PPV and/or continuous positive airway pressure with either a nasal tube or a size 00 soft, round silicone mask. Resuscitation protocols were standardized; respiratory support was provided using a T-piece device commencing in room air. Criteria for intubation included need for cardiac compressions, apnea, continuous positive airway pressure >7 cm H2O, and fraction of inspired oxygen >0.4. Primary outcome was endotracheal intubation in the first 24 hours from birth. RESULTS: Three hundred sixty-three infants were randomly assigned; the study terminated early on the grounds of futility. Baseline variables were similar between groups. Intubation rates in the first 24 hours were 54% and 55% in the nasal tube and face mask groups, respectively (odds ratio: 0.97; 95% confidence interval: 0.63–1.50). There were no important differences in any of the secondary outcomes within the whole cohort or between the 2 gestational age subgroups. CONCLUSIONS: In infants at <30 weeks’ gestation receiving PPV in the DR, there were no differences in short-term outcomes using the nasal tube compared with the face mask.

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Pulmonary-Respiratory Medicine

2001

JAMA

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Airway Obstruction During Mask Ventilation of Very Low Birth Weight Infants During Neonatal Resuscitation

Abstract: Airway obstruction occurs in the majority of the very low birth weight infants who receive ventilation with a face mask during resuscitation and the use of a colorimetric detector can facilitate its recognition and management.

Cited by 166 publications

References 15 publications

Neonatal resuscitation for the preterm infant: evidence versus practice

Neonatal resuscitation for the preterm infant: evidence versus practice

Mask Versus Nasal Tube for Stabilization of Preterm Infants at Birth: A Randomized Controlled Trial

Pulmonary-Respiratory Medicine

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