Distribution of applied forces during face mask ventilation: a preterm neonatal manikin study

Resuscitators may apply different forces to optimize the mask seal during neonatal resuscitation. We investigated the distribution of applied forces across the face of a preterm neonatal manikin during positive pressure ventilation.

This sub-study involved 30 neonatologists and pediatric/anesthesiology residents participating in a scenario of a preterm infant requiring face mask ventilation. The outcome was the force applied on the manikin face by the operator using a soft-cushion anatomical mask. Force was recorded by sensors positioned on the nose, right chin, central chin and left chin. Force-related indicators included maximum force, average peak force and standard deviation of applied forces.

The sensors recorded higher median applied forces on the nose than on the right chin (maximum force: median difference [MD] 0.9 N, 99%CI 0.2 to 1.3; average peak force: MD 0.9 N, 99%CI 0.1 to 1.1). The sensors also recorded higher values of top 10th percentile of applied forces (maximum force, average peak force and standard deviation of applied forces) on the nose, central chin and left chin compared to the right chin.

The participants applied uneven forces across key points of the manikin face during face mask ventilation. Providing trainees with real-time feedback on applied forces may improve the acquisition of PPV skills.

In a preterm neonatal manikin model, health care providers exerted uneven force on different key points of the manikin face during face mask ventilation. The operator may be prone to apply more force on the hand-holding side. Offering real-time feedback on applied forces to trainees may improve the attainment of PPV skills.