One-person versus two-person mask ventilation in preterm infants at birth: a pilot randomised controlled trial

Abstract

Background: Mask leak and airway obstruction are common with mask ventilation in newborn infants, leading to suboptimal ventilation. We aimed to perform a pilot study measuring respiratory mechanics during one-person and two-person mask ventilation in preterm infants at birth.

Methods: Infants less than 30 weeks' gestation were eligible for the study. In the two-person method, one person holds the mask in place and the other provides positive pressure ventilation compared with the standard one-person mask hold. A respiratory function monitor was used in line with a T-piece resuscitator to measure mask leak and airway obstruction. Deferred consent was obtained.

Results: Twenty-five infants were recruited. The mean (SD) birth weight was 920.4 g (188.3), and mean (SD) gestational age was 27.3 weeks (3.0). Percentage mask leak was higher in the one-person mask method (26.4±18.5) compared with the two-person mask method (17.6±9.3) (p=0.018). The mean (SD) expired tidal volume (V_Te, mL) in breaths with leak was 3.9 (1.57) in the one-person method compared with 3.05 (1.0) the two-person method (p=0.31). A significantly lower mean (SD) end-tidal carbon dioxide (EtCO_2, mm Hg) was measured at 25.3 (9.9) in breaths with mask leak, compared with 30.8 (12.1) in breaths without leak. The breaths with airway obstruction had lower mean EtCO₂ (25.9 vs 30.8, p=0.003) and lower mean V_Te (1.71 vs 6.95, p<0.001).

Conclusion: Mask leak and airway obstruction are common in resuscitation of preterm infants at birth. The use of the two-person mask technique is effective and it could be a useful option if mask ventilation with the one-person method is not effective.

Trial registration number: ACTRN12614000245695.

Keywords: Neonatology; Resuscitation.

Figure 1

(A) Airway obstruction during mask ventilation in infant at 28 weeks’ gestation. The solid arrow on the top graph depicts reduction in gas flow with simultaneous reduction in EtCO₂ (broken arrows) and tidal volumes. (B) Mask leak in another infant at 28 weeks’ gestation with the solid line showing inspiratory flow towards the infant but very little coming out. The broken arrow shows the reduction in measured inspiratory pressure with simultaneous reduction in EtCO₂ and tidal volumes.

Figure 2

A two-person technique of mask ventilation.

Figure 3

Graph displaying individual patient mean tidal volume expired (V_Te) mL/kg using one-person and two-person methods, with the area between the horizontal dotted lines depicting the preferred V_Te (4–8 mL/kg) for individual infants.