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); p<0.001) and VTe increased (0.5 mL/kg (-0.5 to 1.7), p=0.028), whereas mask leak (0% (-20 to 1), p=0.12) and percentage of obstructed inflations (0% (0-0), p=0.14) did not change, compared with the period immediately prior to stimulation. Increased duration of stimulation (p<0.001) and surface area of applied stimulus (p=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).