Figure 1 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
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(A) Airway obstruction during mask ventilation in infant at 28 weeks' gestation. The solid arrow on the top graph depicts reduction in gas flow with simultaneous reduction in EtCO 2 (broken arrows) and tidal volumes. (B) Mask leak in another infant at 28 weeks' gestation with the solid line showing inspiratory flow towards the infant but very little coming out. The broken arrow shows the reduction in measured inspiratory pressure with simultaneous reduction in EtCO 2 and tidal volumes.
Source publication
Background
Mask leak and airway obstruction are common with mask ventilation in newborn infants, leading to suboptimal ventilation. We aimed to perform a pilot study measuring respiratory mechanics during one-person and two-person mask ventilation in preterm infants at birth.
Methods
Infants less than 30 weeks’ gestation were eligible for the stud...
Context in source publication
Context 1
... includes an end-tidal carbon dioxide (EtCO 2 ) monitor with an accuracy of 2 mm Hg at 0-40 mm Hg. Airway obstruction was defined as a 75% reduction in expired tidal volume compared with the baseline of 10 inflations prior to the obstructed inflation ( figure 1A). Percentage mask leak was defined as: (tidal volume inspired (V Ti )−tidal volume expired (V Te )/ V Ti ×100); and a mask leak of >75% was considered significant (figure 1B). ...
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Maternal systemic lupus erythematosus (SLE) is at greater risk of pregnancy complications and is associated with increased risk of preterm delivery. However hardly any study has looked at the influence of SLE on the outcomes of preterm infants. This study aimed to explore the influence of SLE on the outcomes of preterm infants.
Method...
Citations
... Wilson [21]. Shah et al. [22] randomized 25 preterm neonates of >30 weeks' gestation to PPV with either one-person or two-person mask hold and reported the mean (SD) FM leak with one-person technique being 26% (19) and with two-person technique being 18% (9). These studies suggest that the use of two-person FM PPV at birth is not only feasible but also may reduce FM air leak rates, thereby providing relatively more efficacious PPV. ...
Background: A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes. Summary: Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO 2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation , but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials. Key Messages: This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions.
