Assessing the effectiveness of two round neonatal resuscitation masks: study 1

Wood, F E; Morley, Colin J; Dawson, Jennifer A; Kamlin, C. Omar F.; Owen, Louise; Donath, Susan; Davis, Peter G

doi:10.1136/adc.2007.117713

Cited by 87 publications

(98 citation statements)

References 6 publications

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“…No study has so far investigated the effect of predefined leak and different RRs on PIP, PEEP, and V t on ventilation parameters. Wood et al [7] compared different neonatal face masks using a manikin and described leaks ranging from almost zero to 100% (mean leak of 55–57%, depending on the mask). In other in vitro studies, Tracy et al [10] found mean leaks of 32%, while O’Donnell et al [8] detected mean ± SD leaks of 65 ± 33% and Schilleman et al [5] described a median of 71% leak.…”

Section: Discussionmentioning

confidence: 99%

“…Today, SIBs and pressure-limited devices (so-called T-piece resuscitators) are commonly used for manual neonatal ventilation, and facemasks are most often used as the interface between the patient and the resuscitation device [1,3,4]. However, considerable leak has been shown to occur when operators with all levels of experience hold the mask on the infant’s face [5,6,7,8,9,10]. Such leaks were found to be underestimated, and were usually not corrected by the operator [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…However, considerable leak has been shown to occur when operators with all levels of experience hold the mask on the infant’s face [5,6,7,8,9,10]. Such leaks were found to be underestimated, and were usually not corrected by the operator [6,7]. While successful ventilation relies on the delivery of sufficient pressures and tidal volumes (V t ) to provide adequate gas exchange, excessive V t is known to injure the lungs of preterm infants [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Leak during Manual Neonatal Ventilation and Its Effect on the Delivered Pressures and Volumes: An in vitro Study

et al. 2012

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Background: Mask leak is a frequent problem during manual ventilation. Our aim was to investigate the effect of predefined leaks on delivered peak inflation pressure (PIP), positive end-expiratory pressure (PEEP) and tidal volume (V_t) when using different neonatal manual ventilation devices. Methods: A neonatal-lung model was ventilated at different respiratory rates (RRs, 40, 60, 80/min) using a mechanically operated self-inflating bag (SIB) and a manually operated T-piece resuscitator (PIP = 20 cm H₂O, PEEP = 5 cm H₂O). Four open tubes of different lengths, which produced up to 90% leak, were consecutively attached between the ventilation device and the lung model. A pneumotachograph was used to measure pressures, flow and volume. Results: With increasing leak (0–90%) PIP and PEEP decreased significantly (p < 0.001) for both devices. Using the SIB, the mean ± SD PIP fell from 20.1 ± 0.3 to 15.9 ± 7 cm H₂O and PEEP fell from 5.0 ± 0 to 0.3 ± 0.5 cm H₂O, leading to an increased pressure difference (Δp); V_t increased from 8.8 ± 0.7 to 11.1 ± 0.8 ml (p < 0.001). With increasing RRs, the leak-dependent changes were significantly lower (p < 0.001). Using the T-piece resuscitator, PIP dropped independent of RRs from 20.3 ± 0.5 to 18.5 ± 0.6 cm H₂O and PEEP from 5.1 ± 0.4 to 4.0 ± 0 cm H₂O, while Δp and V_t did not differ significantly. Conclusion: The decrease in PIP and PEEP with increasing leak is RR dependent and distinctly higher when using an SIB compared to a T-piece device. In contrast to V_t delivered with the SIB, V_t delivered by the T-piece resuscitator was nearly constant even for leaks up to 90%.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leak during Manual Neonatal Ventilation and Its Effect on the Delivered Pressures and Volumes: An in vitro Study

et al. 2012

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“…Nasal prongs may be a more effective device than face masks for providing respiratory support after birth (LOE 2 53 ). There is insufficient evidence to support or refute the use of one type of mask over another for achieving clinical outcome, except that the Rendell-Baker style mask is suboptimal in achieving an adequate seal when used for newborns (LOE 5 54 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 11: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2010

Circulation

563

358

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“…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%

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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Assessing the effectiveness of two round neonatal resuscitation masks: study 1

Abstract: We compared a new neonatal face mask with an established design and found no difference in leak. On average the mask leak was >50% irrespective of operator experience or technique.

Cited by 87 publications

References 6 publications

Leak during Manual Neonatal Ventilation and Its Effect on the Delivered Pressures and Volumes: An in vitro Study

Leak during Manual Neonatal Ventilation and Its Effect on the Delivered Pressures and Volumes: An in vitro Study

Part 11: Neonatal Resuscitation

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

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