Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room.
OBJECTIVE
The aim was to compare resuscitators' estimates of tidal volume (V(T)) and face mask leak with measured values during positive pressure ventilation (PPV) of newborn infants in the delivery room.


METHODS
The authors measured inflating pressures and V(T) delivered using a respiratory function monitor, and calculated face mask leak. After 60 s of PPV, resuscitators were asked to estimate V(T) and face mask leak. These estimates were compared with measurements taken during the previous 30 s.


RESULTS
The authors studied 20 infants who received a mean (SD) of 21 (6) inflations during the 30 s. The median (IQR) expired tidal volume (V(Te)) delivered was 8.7 ml/kg (5.3-11.3). V(Te) varied widely during each resuscitation and between resuscitators. Five resuscitators could not estimate V(Te), one overestimated and 14 underestimated their median delivered V(Te). The median (IQR) face mask leak was 29% (16-63%). Leak also varied widely during each resuscitation and between resuscitators. One resuscitator could not estimate mask leak, four overestimated leak and 15 underestimated leak.


CONCLUSIONS
During face mask ventilation in the delivery room, V(T) and face mask leak were large and variable. The resuscitators were unable to accurately assess their face mask leak or delivered V(T).
Schmölzer
Georg M
GM
Neonatal Services, Department of Newborn Research, The Royal Women's Hospital, Melbourne, Australia. georg.schmoelzer@me.com
Kamlin
Omar C O F
OC
O'Donnell
Colm P F
CP
Dawson
Jennifer A
JA
Morley
Colin J
CJ
Davis
Peter G
PG
D001724:Birth Weight; D002983:Clinical Competence; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D008397:Masks; D009068:Movement; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D011175:Positive-Pressure Respiration / Q000379:methods / Q000592:standards*; D035441:Thoracic Wall / Q000502:physiology; D013990:Tidal Volume / Q000502:physiology