Portal de Periódicos da CAPES

Inherent device: Are neonatologists cool with the face mask for resuscitation at birth, or is further investigation required?

2020; Elsevier BV; Volume: 156; Linguagem: Inglês

10.1016/j.resuscitation.2020.09.024

1873-1570

Calum T. Roberts,

Congenital Diaphragmatic Hernia Studies

Is there a device that we reach for more readily in neonatology than the face mask? It is built into our practice, integral, essential. The stress of attending a neonatal emergency call becomes more manageable as we realise that face mask ventilation is highly effective. In low-income settings, amongst infants with inadequate breathing at birth, use of positive pressure ventilation (PPV) alone results in survival of >90% of infants. 1 Ersdal H.L. Mduma E. Svensen E. Perlman J.M. Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries: a prospective descriptive observational study. Resuscitation. 2012; 83: 869-873 Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar Many infants are in primary apnoea, and the provision of PPV by face mask to aerate the lungs is all that is required to produce an active, breathing, crying baby. This is something we as neonatal clinicians can do to help; it is something that we do well. The notion of neonatologists giving up the face mask may seem as far-fetched as Thomas Pynchon's hippy detective Larry 'Doc' Sportello giving up his dedication to 1960s recreational habits, 2 Pynchon T. Inherent vice. Jonathan Cape, London2009 Google Scholar but should we be so hooked? We have gradually come to learn that we are not using the face mask as well as we think: studies incorporating respiratory function monitoring show that mask leak and obstruction are common with positive pressure ventilation (PPV) delivery by face mask. 3 Schmolzer G.M. Dawson J.A. Kamlin C.O. O'Donnell C.P. Morley C.J. Davis P.G. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2011; 96: F254-F257 Crossref PubMed Scopus (139) Google Scholar , 4 Schmolzer G.M. Kamlin O.C. O'Donnell C.P. Dawson J.A. Morley C.J. Davis P.G. Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2010; 95: F393-F397 Crossref PubMed Scopus (171) Google Scholar , 5 Wood F.E. Morley C.J. Dawson J.A. et al. Assessing the effectiveness of two round neonatal resuscitation masks: study 1. Arch Dis Child Fetal Neonatal Ed. 2008; 93: F235-F237 Crossref PubMed Scopus (69) Google Scholar These issues persist regardless of clinician experience level, so in this setting even practice may not make perfect. How can we do better? Is there a better device?