Relationship between applied face mask force and mask leak during simulated neonatal ventilation: a randomised...

Area of Science:

• Neonatal Resuscitation
• Pediatric Mechanical Ventilation
• Medical Simulation

Background:

• Effective mask ventilation is crucial for neonatal resuscitation.
• Applied force and mask seal are critical factors influencing ventilation delivery.
• Variability in technique may impact ventilation efficacy and safety.

Purpose of the Study:

• To assess the relationship between applied face mask force and mask leak during simulated neonatal ventilation.
• To compare different ventilating devices (self-inflating bag and T-piece) and mask holding techniques (one-hand and two-hand holds).
• To evaluate the impact of force asymmetry on mask seal and ventilation effectiveness.

Main Methods:

• A randomized cross-over simulation study was conducted with 24 experienced neonatal healthcare providers.
• Participants performed simulated ventilation on a manikin for 2 minutes using a self-inflating bag (SIB) with a one-hand hold, or a T-piece device with either a one-hand or two-hand hold.
• Measurements included applied force (under-head and facial), force asymmetry, and mask leak.

Main Results:

• Under-head force was highest with the SIB one-hand hold and lowest with the T-piece one-hand hold.
• Mask leak decreased with increasing applied force, and leak-free ventilation was achieved across all conditions, even with low under-head forces (<10 N).
• Force asymmetry was observed with both one-hand and two-hand holds, with greater forces applied on the side of the non-dominant hand.

Conclusions:

• Applied force and mask leak are dependent on the ventilating device and mask hold technique.
• Leak-free neonatal ventilation can be achieved with relatively low applied forces using either SIB or T-piece devices and various holds.
• Implementing force feedback during training may enhance the effectiveness and safety of neonatal ventilation practices.