Respiratory monitors to teach newborn facemask ventilation: a randomized trial

Newborn facemask ventilation is a difficult skill to master and must be performed accurately, with risks of harm from both underventilation and overventilation. Facemask leak of 30-54% have been reported and operators are frequently unaware of the problem. Furthermore, when learning and performing facemask ventilation, operators often lack objective methods to assess and improve their technique.

The objective of the O’Currain study was to determine whether using a respiratory function monitor (RFM) during mask ventilation training with a manikin reduces facemask leakage. They carried out a randomised control study in 13 hospitals in Australia with 200 participants in each intervention group. An RFM was used by both groups of participants however, only the intervention group could see the display and adjust the airway and mask position until minimal levels of leakage were achieved.

The authors found that, ‘..the addition of an RFM to teach newborn facemask ventilation reduced facemask
leak and increased delivered volume. Less variability in leak and tidal volume was also observed after training with the RFM.’

They suggest that the visual feedback provided by the RFM not only allows the learner to improve their technique through deliberate practice and experimentation, but also allows the learner to correct their mistakes by adjusting hold, facemask position or airway position.
O’Currain and colleagues also highlight that RFMs require some training in their interpretation and suggest coded colors to increase ease of interpretation.

Conclusion

The authors conclude by saying that, ‘This randomised controlled trial indicated that the measurement and feedback of objective respiratory data is associated with improved newborn facemask ventilation skills.’