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Effects of tactile stimulation on spontaneous breathing during face mask ventilation


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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