Respiratory Function Monitor Guidance of Mask Ventilation in the Delivery Room: A Feasibility Study

The transition from intrauterine to extrauterine life that occurs at the time of birth requires timely anatomic and physiologic adjustments to achieve the conversion from placental gas exchange to pulmonary respiration. This transition is brought about by initiation of air breathing and cessation of the placental circulation. Air breathing initiates marked relaxation of pulmonary vascular resistance, with considerable increase in pulmonary blood flow and increased return of now-welloxygenated blood to the left atrium and left ventricle, as well as increased left ventricular output. Removal of the lowresistance placental circuit will increase systemic vascular resistance and blood pressure and reduce right-to-left shunting across the ductus arteriosus. The systemic organs must equally and quickly adjust to the dramatic increase in blood pressure and oxygen exposure. Similarly, intrauterine thermostability must be replaced by neonatal thermoregulation with its inherent increase in oxygen consumption.Approximately 85% of babies born at term will initiate spontaneous respirations within 10 to 30 seconds of birth, an additional 10% will respond during drying and stimulation, approximately 3% will initiate respirations after positive-pressure ventilation (PPV), 2% will be intubated to support respiratory function, and 0.1% will require chest compressions and/or epinephrine to achieve this transition. [1][2][3] Although the vast majority of newborn infants do not require intervention to make these transitional changes, the large number of births worldwide means that many infants require some assistance to achieve cardiorespiratory stability each year.Newly born infants who are breathing or crying and have good tone immediately after birth must be dried and kept warm so as to avoid hypothermia. These actions can be provided with the baby lying on the mother's chest and should not require separation of mother and baby. This does not preclude the need for clinical assessment of the baby. For the approximately 5% of newly born infants who do not initiate respiratory effort after stimulation by drying, and providing warmth to avoid hypothermia, 1 or more of the following actions should be undertaken: providing effective ventilation with a face mask or endotracheal intubation, and administration of chest compressions with or without intravenous medications or volume expansion for those with a persistent heart rate less than 60/min or asystole, despite strategies to achieve effective ventilation (Figure 1).The 2 vital signs that are used to identify the need for an intervention as well as to assess the response to interventions are heart rate and respirations. Progression down the algorithm should proceed only after successful completion of each step, the most critical being effective ventilation. A period of only approximately 60 seconds after birth is allotted to complete each of the first 2 steps, ie, determination of heart rate and institution of effective ventilation. Subsequent progression to the next step will depend o...

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“…232 For the critical outcome of time to heart rate greater than 100/min and neurologically intact survival, we found no evidence.…”

Section: Flow and Volume Monitoringmentioning

confidence: 62%

Part 7: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2015

Circulation

533

256

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“…In addition to ease of use, T-piece resuscitators can consistently provide target inflation pressures and longer inspiratory times in mechanical models, [144][145][146] but there is insufficient evidence to suggest that these qualities result in improved clinical outcomes. 138,139 Use of respiratory mechanics monitors have been reported to prevent excessive pressures and tidal volumes 147 and exhaled CO 2 monitors may help assess that actual gas exchange is occurring during face-mask PPV attempts. 148 Although use of such devices is feasible, thus far their effectiveness, particularly in changing important outcomes, has not been established (Class IIb, LOE C-LD).…”

Section: End-expiratory Pressure Nrp 897mentioning

confidence: 99%

Part 13: Neonatal Resuscitation

Wyckoff¹,

Aziz²,

Escobedo³

et al. 2015

Pediatrics

268

353

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“…138,139 Use of respiratory mechanics monitors have been reported to prevent excessive pressures and tidal volumes 147 and exhaled CO 2 monitors may help assess that actual gas exchange is occurring during face-mask PPV attempts. 148 Although use of such devices is feasible, thus far their effectiveness, particularly in changing important outcomes, has not been established (Class IIb, LOE C-LD).…”

Section: S548 Circulationmentioning

confidence: 99%