End tidal carbon dioxide levels during the resuscitation of prematurely born infants

Prematurely born infants' response to resuscitation via an endotracheal tube or a face mask

“…The ETCO 2 levels prior to the first active inflation in infants resuscitated by either method were close to zero indicating that effective ventilation was not occurring [3]. The first active inflation was almost always associated with significantly higher expiratory tidal volumes and ETCO 2 levels in infants resuscitated either by an endotracheal tube or a face mask.…”

“…The time from the onset of resuscitation to the onset of the first active inflation and, when available, the time from birth to the first active inflation were recorded. Some of the results from infants resuscitated by the face mask have been previously reported [3,4], none of the data collected during resuscitation via an endotracheal tube have been previously reported.…”

“…inflations [3] and in another [4], the median tidal volume delivered in the absence of inspiratory efforts by the infant, was 2.1 ml/kg, which is less than the anatomical dead space. The expired tidal volume, however, was much larger if the infant made an inspiratory effort during the inflation [4], supporting the hypothesis that resuscitation is dependent on stimulating infants to make inspiratory efforts via the Head's paradoxical reflex [1].…”

“…The respiratory function monitor used [3,4] was an NM3 respiratory profile monitor (RPM) (Philips Respironics, Connecticut, USA). The monitor was connected to a Laptop (Dell Latitude, Dell, Bracknell, UK) with customised Spectra software (3.0.1.4) (Grove Medical, London, UK).…”

“…There is, however, evidence that initial resuscitation via a face mask may not result in significant gas exchange until the infants make inspiratory efforts during the inflations [3,4]. In one study, the expired carbon dioxide levels rarely exceeded 0.5 kPa during the first five …”