Mask Ventilation of Preterm Infants in the Delivery Room

In this observational study, infants <32 weeks gestation received mask positive pressure ventilation (PPV) in the delivery room (DR). The study objective was to measure tidal volumes and describe the interactions between spontaneous breaths and PPV inflations during stabilization of preterm infants in the delivery room. The investigators used a respiratory function monitor (RFM) to evaluate the first 5 minutes after birth. Parameters measured included VT, peak inspiratory pressure (PIP), peak end expiratory pressure (PEEP) and mask leak.  

Using data collected from the masked arm of a randomised trial of RFM in the DR,  a total of 3864 PPV inflations and spontaneous breaths were analysed, out of which 1259 could not be interpreted and were excluded. The remaining 2605 PPV inflations and spontaneous breaths were finally included and analysed. 

Substantial leak was observed during all four breath types; inflations, assisted inflations, spontaneous breaths between PPV, and breaths during continuous positive airway pressure (CPAP). The median leaks ranged from 24% to 59% with a wide variability in measured mask leak. As for tidal volume delivery and airway obstructions, the authors reported the delivered tidal volumes to be variable (greatest during inflations and assisted inflations), and in 10% of the infants obstructed inflations during mask PPV were observed. 

Conclusion

The authors conclude that their observations highlight the wide range of tidal volumes delivered and large facemask leaks with both PPV inflations and non-assisted breaths. Considering that data was masked from the clinical team, they believe results to be typical of what occurs in DRs. 

These observations in the DR confirm the presence of large facemask leaks and variability of tidal volume delivery during mask ventilation of preterm infants when operators rely on clinical signs to guide support. The potential of RFM to detect and manage problems associated with mask ventilation in the DR needs to be assessed in large clinical trials.