Comparison of tidal volume and airway pressure during neonatal resuscitation in mask leaks

Providing positive-pressure ventilation (PPV) to the lungs is essential for neonatal resuscitation. Accurate PPV requires a precise measurement of tidal volume and airway pressure, with airway obstruction and mask leakage being the primary concerns for ineffective ventilation. This study aimed to investigate the differences between tidal volume and airway pressure measured by a respiratory function monitor (RFM) and the actual values delivered to the lungs in scenarios involving mask leaks, using a system comprising a PPV device, a face mask, and an artificial lung model.

Three experiments were conducted to assess mask leakage (1) under varying lung conditions, (2) under different ventilation rates, and (3) using different PPV devices. Two RFMs were used, one in the test lung and the other in the mask. Trends in those data were assessed by means of a correlation graph.

Mask leakage resulted in an underestimation of the actual tidal volume, with the effect intensifying as the leak percentage increased. PPV devices using a compressed gas source demonstrated less reduction in lung tidal volume (from 15 to 12 mL) owing to mask leaks compared with those without such a source (from 16 to 5 mL).

Significant discrepancies were observed between RFM readings and test lung values for tidal volume. These findings highlight the importance of accurate monitoring to prevent lung injury caused by excessive tidal volume, particularly in the presence of mask leaks. Accurately measuring tidal volume in the presence of mask leaks presents a significant challenge for the future.