Nasal airway versus oral route for infant resuscitation

Segedin, Elizabeth; Torrie, Jocelyn; Anderson, Brian J.

doi:10.1016/s0140-6736(95)92264-4

Cited by 29 publications

(15 citation statements)

References 2 publications

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“…It is well known that ventilation via the nose leads to improved pulmonary ventilation in three different situations: during anesthesia in adults 19 and infants, 20 when obstructive apnea occurs during sleep, 21,22 and during pediatric CPR. 23 In each of these settings, ventilation via the nose has been shown to be superior to ventilation via the mouth in unconscious, supine humans.…”

mentioning

confidence: 99%

Effectiveness of Breathing through Nasal and Oral Routes in Unconscious Apneic Adult Human Subjects

Jiang

Bao

Liang³

et al. 2011

Anesthesiology

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Background:The authors hypothesized that mouth ventilation by a resuscitator via the nasal route ensures a more patent airway and more effective ventilation than does ventilation via the oral route and therefore would be the optimal manner to ventilate adult patients in emergencies, such as during cardiopulmonary resuscitation. They tested the hypothesis by comparing the effectiveness of mouth-to-nose breathing (MNB) and mouth-to-mouth breathing (MMB) in anesthetized, apneic, adult subjects without muscle paralysis. Methods: Twenty subjects under general anesthesia randomly received MMB and MNB with their heads placed first in a neutral position and then an extended position. A single operator performed MNB and MMB at the target breathing rate of 10 breaths/min, inspiratory:expiratory ratio 1:2 and

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mentioning

confidence: 99%

Effectiveness of Breathing through Nasal and Oral Routes in Unconscious Apneic Adult Human Subjects

Jiang

Bao

Liang³

et al. 2011

Anesthesiology

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“…[5][6][7] The airway anatomy of the infant leads to nasal breathing as the preferred passage for air entry, and unless there is complete nasal obstruction, mouth-to-nose rescue breathing should be feasible if there is a good seal and proper head position. 10 -14 Segedin et al 13 supported the acceptability of nasal rescue breathing when they compared nasalonly to oral-only mask ventilation in 20 infants undergoing general anesthesia. They found the nasal route superior to the oral route but did not compare nasal-only to nose-and-mouth ventilation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Infant Cardiopulmonary Resuscitation Rescue Breathing Technique: Relationship of Infant and Caregiver Facial Measurements

Dembofsky¹,

Gibson²,

Rubin³

et al. 1999

Pediatrics

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ABSTRACT. Objective. Although a few infants ever require resuscitation, pediatric cardiopulmonary resuscitation (CPR) is performed most commonly under 1 year of age. American Heart Association guidelines for pediatric basic life support recommend that the caregiver place his/her mouth over the infant's mouth and nose to create a seal. The way CPR is currently taught encourages parents to attempt to seal the nose and open the mouth of the infant for rescue breathing. Recent studies suggest some parents may have trouble sealing an infant's nose and open mouth, but their study participant numbers were small. The aim of this report is to estimate, among a large cohort, the ability of caregivers to create a seal to their infants for the provision of rescue breathing according to current guidelines.Methods. Infants up to 1 year of age (n ‫؍‬ 281) and their caregivers were enrolled from Philadelphia pediatric offices. Facial measurements of the infants were obtained to estimate the length needed to seal the nose and open mouth, and the nose and closed mouth. Mouth widths of the caregivers were compared with their infant's nose and mouth lengths. One-way analysis of variance with Tukey's postmortem analysis and ordinary least squares means regression were used for univariate analysis with analysis of covariance used to control for the effects of multiple variables when necessary. Infant measurements were stratified into 3-month age quadrants to compare against matched adult caregiver measurements.Results. Most caregivers (n ‫؍‬ 270) were female. Females had smaller mouth widths than males (4.9 ؎ 0.5 cm vs 5.2 ؎ 0.5 cm). Infant nose and mouth length increased during the first year of life, with the largest increase between 0 to 3 months and 3 to 6 months (4.2 ؎ 0.4 cm to 4.7 ؎ 0.4 cm). As infant age and face length increased, a progressively higher rate of adult females were estimated not to be able to cover their infant's nose and open mouth, with the greatest increase again between 0 to 3 months (9%) and 3 to 6 months (40%). All female caregivers except 1 were predicted to be able to seal their infant's nose and closed mouth by our measurements.Conclusions. Infant face length grows rapidly during the first year of life with the most rapid growth occurring during the first 6 months. As early as 3 to 6 months of infant age, many adult caregivers' facial measurements, especially female, predict that they may not be able to

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“…156 -165 Under these conditions, mouth-to-nose ventilation may be adequate. 156,158 There is no convincing data to justify a change from the recommendation that the rescuer attempt mouth-to-mouth-and-nose ventilation for infants up to 1 year of age. During rescue breathing attempts you must maintain good head position for the infant (head tilt-chin lift to maintain a patent airway) and create an airtight seal over the airway.…”

Section: Mouth-to-mouth-and-nose and Mouth-to-mouth Breathingmentioning

confidence: 99%

Part 9: Pediatric Basic Life Support

2000

Circulation

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• The extremely complex skills sequence for lay rescuer relief of foreign-body airway obstruction (FBAO) in the unconscious victim has been simplified. The sequence for healthcare provider relief of FBAO in the unconscious victim remains unchanged (Class IIb). IntroductionPediatric BLS refers to the provision of CPR, with no devices or with bag-mask ventilation or barrier devices, until advanced life support (ALS) can be provided. The population addressed in this chapter includes infants from birth to 1 year of age and children from 1 to 8 years of age. CPR and life support in the pediatric age group should be part of a community-wide Chain of Survival that links the child to the best hope of survival following emergencies. The Chain of Survival integrates education in prevention of cardiopulmonary arrest, BLS, early access to EMS systems prepared for children's needs, early and effective pediatric Sudden cardiopulmonary arrest in infants and children is much less common than sudden cardiac arrest in adults. 4 In contrast to cardiac arrest in adults, cardiac arrest in infants and children is rarely a sudden event, and non-cardiac causes predominate. 4 The etiology of cardiac arrest in infants and children varies by age, setting, and the underlying health of the child. For these reasons, the sequence of CPR for infants and children requires a different approach from that used for adult victims.Cardiac arrest in the under-21-year-old age group occurs most commonly at either end of the age spectrum: under 1 year of age and during the teenage years. In the newly born infant, respiratory failure is the most common cause of cardiopulmonary deterioration and arrest. During infancy the most common causes of arrest include sudden infant death syndrome (SIDS), respiratory diseases, airway obstruction (including foreign-body aspiration), submersion, sepsis, and neurological disease. [5][6][7][8][9][10][11] Beyond 1 year of age, injuries are the leading cause of death. [12][13][14] Cardiac arrest in children typically represents the terminal event of progressive shock or respiratory failure. Either shock or respiratory failure may include a compensated state from which children can rapidly deteriorate to a decompensated condition with progression to respiratory or cardiac arrest. Therefore, rescuers must detect and promptly treat early signs of respiratory and circulatory failure to prevent cardiac arrest. In children, early effective bystander CPR has been associated with successful return of spontaneous circulation and neurologically intact survival. 15,16 BLS courses should be offered to target populations such as expectant parents, child care providers, teachers, sports supervisors, and others who regularly care for children. Parents and child care providers of children with underlying conditions that predispose them to cardiopulmonary failure should be particularly targeted for these courses.These guidelines are based on a review and analysis of clinical and experimental evidence. 17 Because this evidence varies widely...

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Nasal airway versus oral route for infant resuscitation

Cited by 29 publications

References 2 publications

Effectiveness of Breathing through Nasal and Oral Routes in Unconscious Apneic Adult Human Subjects

Effectiveness of Breathing through Nasal and Oral Routes in Unconscious Apneic Adult Human Subjects

Assessment of Infant Cardiopulmonary Resuscitation Rescue Breathing Technique: Relationship of Infant and Caregiver Facial Measurements

Part 9: Pediatric Basic Life Support

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