Delivery of Positive End-Expiratory Pressure Using Self-Inflating Bags during Newborn Resuscitation Is Possible Despite Mask Leak

Abstract

Background: Ventilation is the key intervention to resuscitate non-breathing newborns. Positive end-expiratory pressure (PEEP) may facilitate lung-liquid clearance and help establish functional residual capacity. Objectives: The aim of this study was to describe how mask leak and ventilation rates affect delivered PEEP and tidal volumes during newborn resuscitations using a self-inflating bag with an integrated PEEP valve. Methods: This was an observational study including near-term/term newborns who received bag-mask ventilation (BMV) with a new self-inflating bag with a novel 6 mbar PEEP valve, without external gas flow, between October 1, 2016 and June 30, 2018 in rural Tanzania. Helping Babies Breathe-trained midwives performed most of the resuscitations. Pressures and flow were continuously measured and recorded by resuscitation monitors. Results: In total, 198 newborns with a median gestation of 39 weeks (25th, 75th percentiles 37, 40) and birth weight of 3,100 g (2,580, 3,500) were included. The median delivered PEEP and expired (tid-al) volume at different levels of mask leak were 6.0 mbar and 11.3 mL/kg at 0-20% mask leak, 5.5 mbar and 9.3 mL/kg at 20-40%, 5.2 mbar and 7.8 mL/kg at 40-60%, 4.6 mbar and 5.0 mL/kg at 60-80%, and 1.0 mbar and 0.6 mL/kg at 80-100% mask leak. A high ventilation rate (> 60/min) nearly halved expired volumes compared to < 60/min for 0-60% leak. The BMV rate had a negligible effect on peak inflation pressure (PIP) and PEEP. Conclusions: Mask leak up to 80% did not impair the provision of recommended PEEP or tidal volumes during BMV with a self-inflating bag. High or low ventilation rates did not significantly affect PIP or PEEP. Expired volumes were reduced at ventilation rates > 60/min.

Advanced Clinical Neonatal Nursing Students’ Transfer of Performance: From Skills Training With Real-Time Feedback on Ventilation to a Simulated Neonatal Resuscitation Scenario

“…Our results are in agreement with Gomo et al ( 21 ) who found that mask leakage itself did not impair tidal volume delivery. We found a median mask leak of 30% with feedback and 70% without feedback, but a VT e within the recommended range.…”

“…We found a median mask leak of 30% with feedback and 70% without feedback, but a VT e within the recommended range. Gomo et al ( 21 ) speculated that the leak is not constant but dynamic, which suggests that some variation in leakage and VT e can be tolerated. Notably, in our study, the fraction of correct VT e ’s was very low both in the skills training and simulation.…”

Resuscitation of term and near-term newborns in low-resourced settings: Studies of positive end-expiratory pressure and expired CO2 during bag-mask ventilation at birth

“…Paper III in relation to other ventilation parameters using data from the PEEP-study. 237 PEEP well within intended values was found with mask leak up to 80%, and delivered PEEP was minimally affected by ventilation frequency. The results were significantly different from the results found in the manikin studies mentioned above.…”

“…Papers published by the group range from epidemiological studies and studies to evaluate cost effectiveness of interventions 192,[225][226][227][228][229] via studies of machine learning for automatic interpretation of data [230][231][232] to studies to describe practise, 196 evaluate effect of training methodologies, [233][234][235][236] studies to improve understanding of the basic physiology of newborn transition and resuscitation 74,134,138,221,237 and RCTs to compare new equipment to existing standards. 238,239…”

Versorgung und Reanimation des Neugeborenen nach der Geburt

“…Die Produkteigenschaften verschiedener T-Stück-Systeme und auch selbstfüllender Beatmungsbeutel variieren erheblich, mit Auswirkungen während ihrer Verwendung [243]. Ein neueres vertikales Design von sich selbstfüllenden Beatmungsbeuteln und eine überarbeitete Maske bieten möglicherweise Vorteile in der Handhabung und bei der Verwendung eines endexspiratorischen Drucks [190,[244][245][246].…”