Relationship between applied face mask force and mask leak during simulated neonatal ventilation: a randomised simulation study

Objective Assess the relationship between applied face mask force and leak during simulated ventilation using different ventilating devices and mask holds. Design Randomised cross-over simulation study. Setting Quiet, non-clinical room in children’s hospital. Participants Twenty-four experienced neonatal healthcare providers. Interventions Ventilate a manikin for 2 min per trial, each with three trial conditions: self-inflating bag (SIB) with one-hand hold, T-piece with one-hand hold, T-piece with two-hand hold. Main outcome measures Applied force (newtons (N)) measured under the head and at four locations on the manikin’s face (nasal bridge, mentum, left and right zygomatic arches), force asymmetry applied to the mask rim, and mask leak. Results Under-head force was greatest using the SIB with one-hand hold (mean (SD) 20.53 (5.87) N) and least using the T-piece with one-hand hold (mean (SD) 17.58 (6.11) N). While mask leak was reduced with increasing force, leak-free ventilation was achieved by some participants in all trial conditions with low (<10 N) under-head force. Force asymmetry on the manikin’s face was similar using a one-hand hold compared with a two-hand hold. With both holds, forces were greater on the side of the face corresponding to the operator’s non-dominant hand. Conclusion Applied force and leak varied between devices and mask holds. Force asymmetry was present with both mask holds. Leak-free ventilation could be achieved with small forces using either an SIB or T-piece and either mask hold. Force feedback during training may improve the effectiveness and safety of neonatal ventilation.