title: Compression force on the upper jaw during neonatal intubation: mannequin study.
abstract: OBJECTIVE
  Neonatal intubation is a technically challenging procedure, and pressure-related injuries to surrounding structures have been reported. The primary objective of this study was to determine the pressure exerted on the upper jaw during tracheal intubation using a neonatal mannequin.
  
  
  METHODS
  Multidisciplinary care providers working at a neonatal intensive care unit were requested to intubate a neonatal mannequin using the standard laryngoscope and 3.0-mm (internal diameter) endotracheal tube. Compression force exerted was measured by using pressure-sensitive film taped on the upper jaw before every intubation attempt. Pressure, area under pressure and time taken to intubate were compared between the different types of health-care professionals.
  
  
  RESULTS
  Thirty care providers intubated the mannequin three times each. Pressure impressions were observed on the developer film after every intubation attempt (n = 90). The mean pressure exerted during intubation across all health-care providers was 568 kPa (SD 78). The mean area placed under pressure was 142 mm(2) (SD 45), and the mean time taken for intubation was 14.7 s (SD 4.3). There was no difference in pressure exerted on the upper jaw between frequent and less frequent intubators. It was found that pressure greater than 400 kPa was inadvertently applied on the upper jaw during neonatal intubation, far exceeding the 250 kPa shown to cause tissue injury in animal models.
  
  
  CONCLUSIONS
  The upper jaw is exposed to a significant compression force during intubation. Although such exposure is brief, it has the potential to cause tissue injury. Contact of the laryngoscope blade with the upper jaw occurred in all intubation attempts with the currently used design of laryngoscope.
authors.affiliation: Division of Neonatology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada; JSS Medical College, JSS University, Mysore, Karnataka, India.
authors.forename: Srinivasa Murthy
authors.initials: SM
authors.lastname: Doreswamy
authors.forename: Khaled
authors.initials: K
authors.lastname: Almannaei
authors.forename: Chris
authors.initials: C
authors.lastname: Fusch
authors.forename: Sandesh
authors.initials: S
authors.lastname: Shivananda
mesh_terms: D004867:Equipment Design / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007568:Jaw; D008297:Male; D008348:Manikins; D011312:Pressure / Q000009:adverse effects*; D012151:Resuscitation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods
keywords: compression force; neonatal intubation; upper jaw