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Effects of tactile stimulation on spontaneous breathing during face mask ventilation
  1. Vincent D Gaertner1,
  2. Christoph Martin Rüegger1,
  3. Dirk Bassler1,
  4. Eoin O'Currain2,
  5. C Omar Farouk Kamlin3,4,5,
  6. Stuart B Hooper6,
  7. Peter G Davis3,4,5,
  8. Laila Springer7
  1. 1 Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
  2. 2 School of Medicine, University College Dublin and National Maternity Hospital Dublin, Dublin, Ireland
  3. 3 Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
  4. 4 The University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  6. 6 The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
  7. 7 Department of Neonatology, University Clinic Tubingen, Tubingen, Germany
  1. Correspondence to Dr Vincent D Gaertner, Department of Neonatology, University Hospital Zurich, 8091 Zurich, Switzerland; vincent.gaertner{at}usz.ch

Abstract

Objective We sought to determine the effect of stimulation during positive pressure ventilation (PPV) on the number of spontaneous breaths, exhaled tidal volume (VTe), mask leak and obstruction.

Design Secondary analysis of a prospective, randomised trial comparing two face masks.

Setting Single-centre delivery room study.

Patients Newborn infants ≥34 weeks’ gestation at birth.

Methods Resuscitations were video recorded. Tactile stimulations during PPV were noted and the timing, duration and surface area of applied stimulus were recorded. Respiratory flow waveforms were evaluated to determine the number of spontaneous breaths, VTe, leak and obstruction. Variables were recorded throughout each tactile stimulation episode and compared with those recorded in the same time period immediately before stimulation.

Results Twenty of 40 infants received tactile stimulation during PPV and we recorded 57 stimulations during PPV. During stimulation, the number of spontaneous breaths increased (median difference (IQR): 1 breath (0–3); padj<0.001) and VTe increased (0.5 mL/kg (−0.5 to 1.7), padj=0.028), whereas mask leak (0% (−20 to 1), padj=0.12) and percentage of obstructed inflations (0% (0–0), padj=0.14) did not change, compared with the period immediately prior to stimulation. Increased duration of stimulation (padj<0.001) and surface area of applied stimulus (padj=0.026) were associated with a larger increase in spontaneous breaths in response to tactile stimulation.

Conclusions Tactile stimulation during PPV was associated with an increase in the number of spontaneous breaths compared with immediately before stimulation without a change in mask leak and obstruction. These data inform the discussion on continuing stimulation during PPV in term infants.

Trial registration number Australian and New Zealand Clinical Trial Registry (ACTRN12616000768493).

  • intensive care units
  • neonatal
  • neonatology
  • resuscitation

Data availability statement

Data are available upon reasonable request. De-identified individual participant data are available upon reasonable request from the corresponding author to researchers who provide a methodologically sound proposal, with approval by an independent review committee ('learned intermediary').

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Data availability statement

Data are available upon reasonable request. De-identified individual participant data are available upon reasonable request from the corresponding author to researchers who provide a methodologically sound proposal, with approval by an independent review committee ('learned intermediary').

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Footnotes

  • Contributors All authors were involved in planning, conducting and reporting of the work. VDG and LS conceptualised and designed the study. VDG watched the videos and analysed the flow data, performed data analyses and wrote the first version of the manuscript. LS, CMR and EO collected data for the original trial. CMR, DB, EO, COFK, SBH and PGD provided essential intellectual input to data interpretation as well as manuscript writing. LS supervised the project. VDG is acting as the guarantor of the study. All authors approved the final version of the manuscript.

  • Funding This study was funded by the NHMRC Programme Grant 2017–2021 (App 1113902), (App ID 1059111, to PGD), (App ID 1073533, to COFK). VDG received an Endeavour Research Fellowship (Australia) (ERF_RDDH_5276_2016) and a Start-Up grant by the European Society for Paediatric Research. LS received a research fellowship from the German Research Society (DFG-grant LO 2162/1-1). CMR received an early Postdoc Mobility fellowship from the Swiss National Science Foundation (P2ZHP3_161749).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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