An approach to define newborns´ sniffing position using an angle based on reproducible facial landmarks.
airway obstruction
mask ventilation
neutral position
newborn
preterm
sniffing position
Journal
Paediatric anaesthesia
ISSN: 1460-9592
Titre abrégé: Paediatr Anaesth
Pays: France
ID NLM: 9206575
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
04
01
2021
received:
02
10
2020
accepted:
13
01
2021
pubmed:
9
2
2021
medline:
4
8
2021
entrez:
8
2
2021
Statut:
ppublish
Résumé
The neutral or sniffing position is advised for mask ventilation in neonates to avoid airway obstruction. As definitions are manifold and often unspecific, we wanted to investigate the reliability and reproducibility of angle measurements based on facial landmarks that may be used in future clinical trials to determine a hypothetical head position with minimal airway obstruction during mask ventilation. In a prospective single-center observational study, 2D sagittal photographs of 24 near-term and term infants were taken, with five raters marking facial landmarks to assess interobserver agreement of those landmarks and angle δ, defined as the angle between the line parallel to the lying surface and the line crossing Subnasale (Sn) and Porion' (P'). Angle δ was assessed in sniffing (δ Infants had a mean (SD) gestational age of 37.3 (2.3) weeks. Angle δ could be determined in all 48 images taken in either the sniffing or the physiological head position. Interobserver correlation coefficient was 98.6 for all measurements independent of head position. Angle δ This study provides a new measuring technique using an angle that is reproducible and reliable and may be used in future studies to correlate head position with airway obstruction.
Sections du résumé
BACKGROUND
The neutral or sniffing position is advised for mask ventilation in neonates to avoid airway obstruction. As definitions are manifold and often unspecific, we wanted to investigate the reliability and reproducibility of angle measurements based on facial landmarks that may be used in future clinical trials to determine a hypothetical head position with minimal airway obstruction during mask ventilation.
METHODS
In a prospective single-center observational study, 2D sagittal photographs of 24 near-term and term infants were taken, with five raters marking facial landmarks to assess interobserver agreement of those landmarks and angle δ, defined as the angle between the line parallel to the lying surface and the line crossing Subnasale (Sn) and Porion' (P'). Angle δ was assessed in sniffing (δ
RESULTS
Infants had a mean (SD) gestational age of 37.3 (2.3) weeks. Angle δ could be determined in all 48 images taken in either the sniffing or the physiological head position. Interobserver correlation coefficient was 98.6 for all measurements independent of head position. Angle δ
CONCLUSIONS
This study provides a new measuring technique using an angle that is reproducible and reliable and may be used in future studies to correlate head position with airway obstruction.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
404-409Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
Singhal N, McMillan DD, Yee WH, Akierman AR, Yee YJ. Evaluation of the effectiveness of the standardized neonatal resuscitation program. J Perinatol. 2001;21(6):388-392.
Foglia EE, Te Pas AB. Effective ventilation: The most critical intervention for successful delivery room resuscitation. Semin Fetal Neonatal Med. 2018;23(5):340-346.
Sawyer T, Umoren RA, Gray MM. Neonatal resuscitation: advances in training and practice. Adv Med Educ Pract. 2017;8:11-19.
Schilleman K, Witlox RS, Lopriore E, Morley CJ, Walther FJ, te Pas AB. Leak and obstruction with mask ventilation during simulated neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2010;95(6):F398-402.
Schmolzer GM, Dawson JA, Kamlin CO, O'Donnell CP, Morley CJ, Davis PG. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2011;96(4):F254-F257.
Finer NN, Rich W, Wang C, Leone T. Airway obstruction during mask ventilation of very low birth weight infants during neonatal resuscitation. Pediatrics. 2009;123(3):865-869.
Schmolzer GM, Kamlin OC, O'Donnell CP, Dawson JA, Morley CJ, Davis PG. Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2010;95(6):F393-F397.
Tracy MB, Klimek J, Coughtrey H, et al. Mask leak in one-person mask ventilation compared to two-person in newborn infant manikin study. Arch Dis Child Fetal Neonatal Ed. 2011;96(3):F195-200.
Schmolzer GM, Kamlin OC, Dawson JA, te Pas AB, Morley CJ, Davis PG. Respiratory monitoring of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2010;95(4):F295-303.
Rafferty AR, Johnson L, Davis PG, Dawson JA, Thio M, Owen LS. Neonatal mannequin comparison of the Upright self-inflating bag and snap-fit mask versus standard resuscitators and masks: leak, applied load and tidal volumes. Arch Dis Child Fetal Neonatal Ed. 2018;103(6):F562-F566.
Crawshaw JR, Kitchen MJ, Binder-Heschl C, et al. Laryngeal closure impedes non-invasive ventilation at birth. Arch Dis Child Fetal Neonatal Ed. 2018;103(2):F112-F119.
Ostgaard G, Ulvik A. Paediatric anaesthesia. Tidsskr Nor Laegeforen. 2010;130(7):752-755.
Wiechers C, Buchenau W, Arand J, et al. Mandibular growth in infants with Robin sequence treated with the Tubingen palatal plate. Head Face Med. 2019;15(1):17.
Raju U, Sondhi V, Patnaik SK. Meconium Aspiration Syndrome: An Insight. Med J Armed Forces India. 2010;66(2):152-157.
Wyllie J, Bruinenberg J, Roehr CC, Rudiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation. 2015;95:249-263.
Hirsch NP, Smith GB, Hirsch PO. Alfred Kirstein. Pioneer of direct laryngoscopy. Anaesthesia. 1986;41(1):42-45.
Nypaver M, Treloar D. Neutral cervical spine positioning in children. Ann Emerg Med. 1994;23(2):208-211.
Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (Reprint). Pediatrics. 2015;136(Suppl 2):S120-S166.
Safar P. Ventilatory efficacy of mouth-to-mouth artificial respiration; airway obstruction during manual and mouth-to-mouth artificial respiration. J Am Med Assoc. 1958;167(3):335-341.
Chua C, Schmolzer GM, Davis PG. Airway manoeuvres to achieve upper airway patency during mask ventilation in newborn infants - An historical perspective. Resuscitation. 2012;83(4):411-416.
Bhalala US, Hemani M, Shah M, et al. Defining Optimal Head-Tilt Position of Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data. PLoS One. 2016;11(3):e0151789.
Schwarz AM. What every doctor should know about the orthopedics of the jaw in childhood. Munch Med Wochenschr. 1961;103:601-605.
Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9(7):671-675.
Katina S, McNeil K, Ayoub A, et al. The definitions of three-dimensional landmarks on the human face: an interdisciplinary view. J Anat. 2016;228(3):355-365.
Atanelov Z, Aina T, Rebstock SE. Nasopharyngeal Airway. Treasure Island, FL: StatPearls; 2020.
Atkins DL, de Caen AR, Berger S, et al. 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;137(1):e1-e6.
Nolan JP, Soar J, Zideman DA, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010;81(10):1219-1276.
Lütcke S, Mang H, Schmitt HJ, Schmid MC. Pictorial representations of orotracheal intubation in the medical literature. Anästh Intensivmed. 2011;52:681-692.
Institute of Medicine. Assessment of the NIOSH Head-and-Face Anthropometric Survey of U.S. Respirator Users. The National Academies Press, Washington, DC. 2007.
Kattan EE, Kattan ME, Elhiny OA. A New Horizontal Plane of the Head. Open Access Maced J Med Sci. 2018;6(5):767-771.
Lundstrom A, Lundstrom F. The Frankfort horizontal as a basis for cephalometric analysis. Am J Orthod Dentofacial Orthop. 1995;107(5):537-540.
Ishizaka S, Moromugi S, Kobayashi M, et al. A Remote-Controlled Airbag Device Can Improve Upper Airway Collapsibility by Producing Head Elevation With Jaw Closure in Normal Subjects Under Propofol Anesthesia. IEEE J Transl Eng Health Med. 2014;2:2600109.
von Ungern-Sternberg BS, Erb TO, Reber A, Frei FJ. Opening the upper airway-airway maneuvers in pediatric anesthesia. Paediatr Anaesth. 2005;15(3):181-189.
Kaufman J, Schmolzer GM, Kamlin CO, Davis PG. Mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2013;98(5):F405-F410.