Improving Assessment During Noninvasive Ventilation in the Delivery Room

Abstract

The efficacy of mask ventilation has traditionally been judged by evaluating clinical signs alone (eg, assessment of heart rate, chest movements, skin color), which can be misleading. Despite the recent introduction of extended noninvasive monitoring, neonatal resuscitation remains challenging. This article discusses the current evidence on clinical assessment and monitoring during noninvasive mask ventilation in the delivery room. Potential pitfalls during mask ventilation are discussed, which may be identified with structured neonatal resuscitation courses, video recording, or extended physiological monitoring. Successful placement of a correctly positioned endotracheal tube by junior medical staff is <50%, and accidental esophageal intubation is common. Clinical signs are subjective and can be misleading, and recognition of esophageal placement of the endotracheal tube, by using clinical assessment alone, can take up to several minutes. Because carbon dioxide is exhaled at much higher concentrations than inhaled, it can be detected with semiquantitative colorimetric devices, or devices that display numeric or graphic values. In the section on carbon dioxide detectors, the current evidence (along with limitations) concerning these devices is discussed.