Tidal volumes during delivery room stabilization of (near) term infants

Abstract

Background We sought to assess tidal volumes in (near) term infants during delivery room stabilization. Methods Secondary analysis of a prospective study comparing two facemasks used for positive pressure ventilation (PPV) in newborn infants ≥ 34 weeks gestation. PPV was provided with a T-piece device with a PIP of 30 cmH2O and positive end-expiratory airway pressure of 5 cmH2O. Expired tidal volumes (Vt) were measured with a respiratory function monitor. Target range for Vt was defined to be 4 – 8 ml/kg. Results Twenty-three infants with a median (IQR) gestational age of 38.1 (36.4 – 39.0) weeks received 1828 inflations with a median Vt of 4.6 (3.3 – 6.2) ml/kg. Median Vt was in the target range in 12 infants (52%), lower in 9 (39%) and higher in 2 (9%). Thirty-six (25—27) % of the inflations were in the target rage over the duration of PPV while 42 (25 – 65) % and 10 (3 – 33) % were above and below target range. Conclusions Variability of expiratory tidal volume delivered to term and late preterm infants was wide. Reliance on standard pressures and clinical signs may be insufficient to provide safe and effective ventilation in the delivery room. Trial registration This is a secondary analysis of a prospectively registered randomized controlled trial (ACTRN12616000768493).

Use of laryngeal mask for neonatal resuscitation in Brazil: A national survey

“… 2 Leakage around the mask is one of the main problems related to its use, with losses of 50–70% of the delivered flow. 8 , 17 This leak is not always perceived by the professionals, causing insufficient delivery of tidal volume and compromising the success of PPV. 18 , 19 The application of the mask to the face of the newborn can also trigger the trigeminal-cardiac reflex, with consequent stimulation of the brainstem nuclei, causing apnea, bradycardia, and hypotension through reflex vagal action.…”

“…A number of studies show that supraglottic devices may be more effective than FMs for performing PPV in late preterm and term newborns immediately after birth, reducing the need for endotracheal intubation, which can be attributed mainly to the lower occurrence of gas leakage between the mask and the newborn's face. 10 , 17 , 22 , 23 , 24 An effective lung ventilation may also be delayed because of the difficulties related to tracheal intubation. 24 , 25 In a prospective study conducted in neonatal intensive care units, intubation success rates ranged from 20% to 72% according to the practitioner’s experience.…”

Incomplete Exhalation during Resuscitation—Theoretical Review and Examples from Ventilation of Newborn Term Infants

“…During resuscitation, the large variation in delivered tidal volume has been explained not only by change in compliance, but also leakage, obstruction, and spontaneous breathing efforts [23,26].…”