Applied forces with high vs. low resuscitation table during neonatal ventilation: a randomized crossover manikin study

We compared applied forces on a newborn manikin face, cuff pressure, and air leak during positive pressure ventilation with a high vs. low resuscitation table. A randomized controlled crossover (AB/BA) trial of face mask ventilation where a neonatal manikin was placed on the resuscitation table adjusted to level operator's xiphoid (high table positioning) or operator's navel (low table positioning). Twenty-eight neonatologists and pediatric residents participated. The primary outcome measure was the force applied to the manikin face. The secondary outcome measures included the cuff pressure, the percentage of ventilation time with a leak of less than 25% around the mask, and participants' opinions on the procedures. Chin, cheekbone, and nose bridge sensors recorded higher top 10th percentile of applied forces with high vs. low table. The median and top 10th percentile of cuff pressures were higher with the high table. The ventilation time with mask leak < 25% was not statistically different between the two table elevations. Participants provided comparable opinions about the difficulty in providing effective ventilation, fatigue in obtaining a good mask seal, and satisfaction about the mask seal.

In a neonatal manikin model, the lower force applied during positive pressure ventilation with the resuscitation table at the operator's navel may be a desirable goal, but the clinical validations should be assessed in further studies.

clinicaltrial.gov NCT06254651.

• Apnoea and bradycardia may occur more frequently when higher forces are exerted during face mask ventilation in preterm infants immediately after birth • As the quality of the ventilation may be influenced by procedure-related factors such as the position of the patient, we hypothesized that the height of the resuscitation table could influence the applied forces during the procedure.

• In a neonatal manikin model, the lower force applied during face mask ventilation with the resuscitation table at the operator's navel may be a desirable goal. • Further studies in a clinical setting are warranted.