Leak and obstruction with mask ventilation during simulated neonatal resuscitation

Schilleman, Kim; Witlox, Ruben S G M; Lopriore, Enrico; Morley, Colin J; Walther, Frans J.; Pas, Arjan B. te

doi:10.1136/adc.2009.182162

Cited by 88 publications

(93 citation statements)

References 15 publications

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“…19 A recent systematic review and metaanalysis noted that compared with no intervention (eg, a control group or preintervention assessment), simulationbased training was effective in improving the knowledge, skills, and behaviors of health care professionals. 1 In pediatrics, simulation has been effectively used to teach neonatal [20][21][22] and pediatric resuscitation, 3,6,7 crisis resource management, 8,9,20,[23][24] anesthesia, [25][26][27] procedural skills 5,[28][29][30] (eg, gynecology examination, airway management), and surgical skills [31][32][33] (eg, endoscopy and minimally invasive surgery). Although the scope of simulation-based education in pediatrics is growing, few comparative studies have helped to clearly define the optimal instructional design features of effective pediatric SBEI.…”

Section: Categories Of Sbr Research On the Efficacy Of Simulation As mentioning

confidence: 99%

Designing and Conducting Simulation-Based Research

et al. 2014

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As simulation is increasingly used to study questions pertaining to pediatrics, it is important that investigators use rigorous methods to conduct their research. In this article, we discuss several important aspects of conducting simulation-based research in pediatrics. First, we describe, from a pediatric perspective, the 2 main types of simulationbased research: (1) studies that assess the efficacy of simulation as a training methodology and (2) studies where simulation is used as an investigative methodology. We provide a framework to help structure research questions for each type of research and describe illustrative examples of published research in pediatrics using these 2 frameworks. Second, we highlight the benefits of simulation-based research and how these apply to pediatrics. Third, we describe simulation-specific confounding variables that serve as threats to the internal validity of simulation studies and offer strategies to mitigate these confounders. Finally, we discuss the various types of outcome measures available for simulation research and offer a list of validated pediatric assessment tools that can be used in future simulation-based studies.

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Section: Categories Of Sbr Research On the Efficacy Of Simulation As mentioning

confidence: 99%

Designing and Conducting Simulation-Based Research

et al. 2014

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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%

“…[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.…”

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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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“…Adequate noninvasive ventilation using a mask as interface plays an important role in neonatal resuscitation [1,2,3,4]. It has been suggested that a respiratory function monitor as a feedback device during neonatal resuscitation will be helpful and can inform the clinician about the tidal volumes delivered and whether mask leak occurs [5].…”

Section: Introductionmentioning

confidence: 99%

Influence of the Hand Squeeze and Mask Distensibility on Tidal Volume Measurements during Neonatal Mask Ventilation

Vonderen¹,

Kamar²,

Schilleman³

et al. 2013

Neonatology

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Background: During mask ventilation, the mask volume can vary as it is pressurized or when it is squeezed. The change in volume of the mask may affect tidal volumes delivered and difference in inspired (V_ti) and expired tidal volumes (V_te). Objectives: To investigate whether hand squeeze and distensibility of the mask during ventilation influences tidal volume measurements. Methods: For both experiments, we ventilated a leak-free mask ventilation model using pressures of 25/5 cm H₂O through a t-piece. V_ti and V_te were measured. (A) Two consultants performed mask ventilation with (1) consistent hand squeeze, (2) release during inflation and squeeze during expiration, (3) squeeze during inflation, release during expiration, and (4) gentle squeeze. Results: (B) Thirty caregivers performed mask ventilation. Experiment A: V_ti was different during consistent hold (1) 8.1 ml (0.4) and loose grip (4) 8.2 ml (0.3), compared to squeezing during inflation (2) 18.9 ml (1.9), or expiration (3) 6.4 ml (3.5). Variance in difference between V_ti and V_te occurred only when the mask was squeezed during inflation (-47.4% (101.5)). Experiment B: volumes measured were consistent (intraindividual CV 3-5%, interindividual CV 9-10%). When comparing gas flow rate of 6-10 l/min, volumes increased by approximately 8%, differences in V_ti and V_te were small with both flow settings (-0.9% (-3.9-1.4) and -0.6% (-3.3-1.8); n.s.). Conclusion: Variation in mask hold during mask ventilation can influence volume measurement, but this hardly occurs when testing caregivers.

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Leak and obstruction with mask ventilation during simulated neonatal resuscitation

Cited by 88 publications

References 15 publications

Designing and Conducting Simulation-Based Research

Designing and Conducting Simulation-Based Research

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

Influence of the Hand Squeeze and Mask Distensibility on Tidal Volume Measurements during Neonatal Mask Ventilation

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