title: Compressive force applied to a manikin's head during mask ventilation.
abstract: OBJECTIVE
  To investigate the compressive force applied to the head during mask ventilation and determine whether this force increases in response to an attempt to correct the mask leak.
  
  
  METHODS
  The authors asked 24 participants (consultants, fellows and nurses) to administer positive pressure ventilation to a modified leak-free, term newborn manikin using a self-inflating bag (SIB) and a Neopuff T-piece device. Recordings were made before and after the participants were informed about their percentage of mask leak and asked to correct this. Airway pressure and flow were measured using a Florian monitor, and the force applied to the head was measured using a concealed custom-made load cell weighing scale.
  
  
  RESULTS
  There were no differences in the mean (SD) force applied to the head between devices used and before or after the attempt to correct the mask leak (SIB before 2215 (892) and after 2195 (989) g; Neopuff before 1949 (957) and after 2028 (909) g). There was a large variation in force with both devices before and after the attempt (coefficient of variation: SIB before 40% and after 45%; Neopuff before 50% and after 45%). There was no correlation between mask leak and the difference in force used before and after the attempt to correct the mask leak using both devices.
  
  
  CONCLUSIONS
  During mask ventilation of a manikin, the authors observed that large forces were exerted on the head with either an SIB or a Neopuff, but these forces did not increase during the attempt to minimise the mask leak.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: van Vonderen
authors.forename: Ted A
authors.initials: TA
authors.lastname: Kleijn
authors.forename: Kim
authors.initials: K
authors.lastname: Schilleman
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Walther
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Hooper
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D000402:Airway Obstruction / Q000209:etiology; D004867:Equipment Design; D004868:Equipment Failure; D006257:Head / Q000503:physiopathology*; D006801:Humans; D007224:Infant Care / Q000295:instrumentation / Q000379:methods; D007231:Infant, Newborn / Q000502:physiology*; D008348:Manikins; D008397:Masks; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013314:Stress, Mechanical