Clinical trial NCT06161389: Applied Forces During Neonatal Face Mask Ventilation With Different Face-mask Air Cushion Volumes
Official title: Applied Forces During Neonatal Face Mask Ventilation With Different Face-mask Air Cushion
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Positive Pressure Ventilation
Preterm Infants
Apnea
Lead sponsor: University Hospital Padova
Sponsor class: OTHER
First posted: 2023-12-07
Enrollment: 28
Sex: ALL
Minimum age (years): 25
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: TREATMENT

Brief summary: Positive pressure ventilation (PPV) is the most important intervention in neonatal resuscitation. During PPV, it is important to hold the face-mask with care, as applying excessive pressure could cause injury to the infant, while insufficient pressure could be a contributor of mask leak and reduced effective ventilation. Application of positive pressure to face structures may trigger a vagally mediated reflex via the trigeminal nerve that innervates the skin of the face leading to apnoea and a decrease in heart rate (TCR, trigeminal-cardiac reflex).

In neonatal manikins, ventilation with a partially or fully inflated face mask does not seem to result in differences in mask leak. The force exerted by providers to improve mask seal might result in pressure lesions and in the elicitation of the trigeminal-cardiac reflex. However, information about the applied forces is unknown.


Eligibility criteria: Inclusion Criteria:

* Level III NICU consultants and pediatric residents

Exclusion Criteria:

* None

Primary outcomes:
measure: Applied forces on the manikin face
timeFrame: 1 minute
Secondary outcomes:
measure: Cuff pressure
timeFrame: 1 minute
measure: Percentage of ventilation time with leak less than 25% around the mask
timeFrame: 1 minute
Other outcomes:
measure: Participants' opinion on the procedures
timeFrame: 5 minutes
Locations:
city: Padova
country: Italy
facility: Azienda Ospedaliera di Padova, University of Padova
Study officials:
References:
citation: Madar J, Roehr CC, Ainsworth S, Ersdal H, Morley C, Rudiger M, Skare C, Szczapa T, Te Pas A, Trevisanuto D, Urlesberger B, Wilkinson D, Wyllie JP. European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation. 2021 Apr;161:291-326. doi: 10.1016/j.resuscitation.2021.02.014. Epub 2021 Mar 24.
citation: Schilleman K, Witlox RS, Lopriore E, Morley CJ, Walther FJ, te Pas AB. Leak and obstruction with mask ventilation during simulated neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2010 Nov;95(6):F398-402. doi: 10.1136/adc.2009.182162. Epub 2010 Jun 30.
citation: van Vonderen JJ, Kleijn TA, Schilleman K, Walther FJ, Hooper SB, te Pas AB. Compressive force applied to a manikin's head during mask ventilation. Arch Dis Child Fetal Neonatal Ed. 2012 Jul;97(4):F254-8. doi: 10.1136/archdischild-2011-300336. Epub 2011 Dec 5.
citation: Cavallin F, Sala C, Maglio S, Bua B, Villani PE, Menciassi A, Tognarelli S, Trevisanuto D. Applied forces with direct versus indirect laryngoscopy in neonatal intubation: a randomized crossover mannequin study. Can J Anaesth. 2023 May;70(5):861-868. doi: 10.1007/s12630-023-02402-9. Epub 2023 Feb 14.