Abstract
Background and aims: International guidelines recommend that positive pressure ventilation (PPV) in the delivery room (DR) is guided by chest rise and heart rate. Tidal volume (VT) delivery during resuscitation is highly variable and we have shown that resuscitators cannot accurately estimate tidal volume delivery (Schmölzer, ESPR 2009).
To determine if resuscitators can deliver more appropriate tidal volumes and reduce mask leak by using a respiratory function monitor (RFM) during PPV in the DR.
Methods: Infants < 32/40 receiving PPV had a flow sensor placed between the mask and a T-piece. Resuscitators were randomly allocated to have the RFM visible or covered. All resuscitators were trained in the use of the RFM. When the RFM was visible, resuscitators were encouraged to use the display to deliver an expired VT between 4- 8mL/ kg with minimal leak. We compared the expired VT, mask leak, airway pressures, ventilation rate and inflation time between the two groups.
Results: 56 infants were enrolled; mean(SD) gestation 28(2) wks and birthweight 994(331)g, 28(50%) male and 40(72%) born by caesarean section. Median(IQR) Apgar-scores at 1 and 5 minutes 5(4-6) and 8(7-8). Mean(SD) expired VT for RFM visible and covered were 6.5(3)mL/kg and 8.4(3.5)mL/kg (p=0.043). The mean(SD) facemask leak for the two groups were 39(16)% and 48(22)% (p=0.13). There were no significant differences in ventilation rate, inflation time or airway pressures.
Conclusion: The use of a RFM during PPV in the DR enabled resuscitators to adjust their technique and reduced infants' exposure to potentially harmful tidal volume.
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Schmölzer, G., Morley, C., Kamlin, O. et al. 332 Use of a Respiratory Function Monitor During Positive Pressure Ventilation in the Delivery Room -A Randomized Trial. Pediatr Res 68 (Suppl 1), 171 (2010). https://doi.org/10.1203/00006450-201011001-00332
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DOI: https://doi.org/10.1203/00006450-201011001-00332