title: Prematurely born infants' response to resuscitation via an endotracheal tube or a face mask.
abstract: BACKGROUND
  Prematurely born infants may be resuscitated in the labour suite via a face mask or an endotracheal tube.
  
  
  OBJECTIVE
  To assess prematurely born infants' initial responses to resuscitation delivered via an endotracheal tube or a face mask, to determine if the first five inflations via an endotracheal tube produced expired tidal volumes greater than 4.4ml/kg (twice the anatomical dead space) and whether the outcome of initial resuscitation via an endotracheal tube or via a face mask differed according to the first active inflation (the infant's inspiratory effort coinciding with an inflation).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Thirty-five infants (median gestational age 25, range 23-27weeks) requiring resuscitation via an endotracheal tube (n=20) or a face mask (n=15) were studied.
  
  
  METHODS
  Inflation pressures, inflation times, expiratory tidal volumes, end tidal carbon dioxide (ETCO2) and leak were recorded.
  
  
  RESULTS
  Before the first active inflation, only 27% of infants receiving resuscitation via an endotracheal tube had expiratory volumes greater than 4.4ml/kg. During, both endotracheal and face mask initial resuscitations, during the first active inflation the expired tidal volumes (7.7ml/kg, 5.2ml/kg) and ETCO2 levels (4.8kPa, 3.2kPa) were significantly higher than during the inflations before the first active inflation (2.8ml/kg, 1.6ml/kg; 0.36kPa, 0.2kPa respectively) (all p<0.001).
  
  
  CONCLUSIONS
  Initial resuscitation via an endotracheal tube using currently recommended pressures, rarely produced adequate tidal volumes. Resuscitation via an endotracheal tube or a face mask was most effective when the infant's inspiratory effort coincided with an inflation.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, UK.
authors.forename: Vadivelam
authors.initials: V
authors.lastname: Murthy
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, UK.
authors.forename: Walton
authors.initials: W
authors.lastname: D'Costa
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, UK.
authors.forename: Raajul
authors.initials: R
authors.lastname: Shah
authors.affiliation: Evelina Children's Hospital Neonatal Unit, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: Grenville F
authors.initials: GF
authors.lastname: Fox
authors.affiliation: Neonatal Unit, Southern General Hospital, Scotland, UK; Neonatal Unit, Yorkhill Hospital, Scotland, UK.
authors.forename: Morag E
authors.initials: ME
authors.lastname: Campbell
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Milner
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, UK; NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust and King's College London, UK. Electronic address: anne.greenough@kcl.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods
keywords: Face mask; Intubation; Preterm infant; Resuscitation