title: Leak and obstruction with mask ventilation during simulated neonatal resuscitation.
abstract: OBJECTIVE
  To evaluate mask technique during simulated neonatal resuscitation and test the effectiveness of training in optimal mask handling.
  
  
  METHODS
  Seventy participants(consultants, registrars and nurses) from neonatal units were asked to administer positive pressure ventilation at a flow of 8 l/min and a frequency of 40-60/min to a modified leak free, term newborn manikin (lung compliance 0.5 ml/cm H(2)O) using a Neopuff T-piece device. Recordings were made (1) before training, (2) after training in mask handling and (3) 3 weeks later. Leak was calculated. Obstruction (tidal volume <60% of optimal tidal volume) and severe obstruction (<30% of optimal tidal volume) were calculated when leak was minimal.
  
  
  RESULTS
  For the 70 participants, median (IQR) leak was 71% (32-95%) before training, 10% (5-37%) directly after training and 15% (4-33%) 3 weeks later (p<0.001). When leak was minimal, gas flow obstruction was observed before, directly after training and 3 weeks later in 46%, 42% and 37% of inflations, respectively. Severe obstruction did not occur.
  
  
  CONCLUSIONS
  Mask ventilation during simulated neonatal resuscitation was often hampered by large leaks at the face mask. Moderate airway obstruction occurred frequently when effort was taken to minimise leak. Training in mask ventilation reduced mask leak but should also focus on preventing airway obstruction.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: Schilleman
authors.forename: Ruben S
authors.initials: RS
authors.lastname: Witlox
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Morley
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Walther
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D000402:Airway Obstruction / Q000209:etiology*; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D006801:Humans; D007231:Infant, Newborn; D008348:Manikins; D008397:Masks; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000295:instrumentation / Q000592:standards; D012151:Resuscitation / Q000009:adverse effects* / Q000193:education / Q000295:instrumentation / Q000592:standards