Prematurely born infants' response to resuscitation via an endotracheal tube or a face mask

•Endotracheal tube resuscitation rarely produced tidal volumes (TVs) > 4.4 ml/kg.•The first active inflation significantly increased TVs and end tidal CO2 levels.•Resuscitation was most effective when a respiratory effort coincided with inflation.

BackgroundPrematurely born infants may be resuscitated in the labour suite via a face mask or an endotracheal tube.AimsTo assess prematurely born infants' initial responses to resuscitation delivered via an endotracheal tube or a face mask, to determine if the first five inflations via an endotracheal tube produced expired tidal volumes greater than 4.4 ml/kg (twice the anatomical dead space) and whether the outcome of initial resuscitation via an endotracheal tube or via a face mask differed according to the first active inflation (the infant's inspiratory effort coinciding with an inflation).Study designProspective observational study.SubjectsThirty-five infants (median gestational age 25, range 23–27 weeks) requiring resuscitation via an endotracheal tube (n = 20) or a face mask (n = 15) were studied.Outcome measuresInflation pressures, inflation times, expiratory tidal volumes, end tidal carbon dioxide (ETCO2) and leak were recorded.ResultsBefore the first active inflation, only 27% of infants receiving resuscitation via an endotracheal tube had expiratory volumes greater than 4.4 ml/kg. During, both endotracheal and face mask initial resuscitations, during the first active inflation the expired tidal volumes (7.7 ml/kg, 5.2 ml/kg) and ETCO2 levels (4.8 kPa, 3.2 kPa) were significantly higher than during the inflations before the first active inflation (2.8 ml/kg, 1.6 ml/kg; 0.36 kPa, 0.2 kPa respectively) (all p < 0.001).ConclusionsInitial resuscitation via an endotracheal tube using currently recommended pressures, rarely produced adequate tidal volumes. Resuscitation via an endotracheal tube or a face mask was most effective when the infant's inspiratory effort coincided with an inflation.