Background Assessment of effective positive pressure ventilation (PPV) in neonatal mask ventilation can be difficult.

Objectives To determine which was the most effective method of providing PPV: a T-piece resuscitator (TPR) with no device attached (ND), a TPR containing an in line CO₂ detector (Neo-StatCO₂ <Kg^®) (COD) or a TPR with a capnography device attached (CAP).

Methods This was a randomised crossover trial. Neonatal trainees were randomly assigned to each method (ND, COD or CAP). They then alternated methods such that all participants provided PPV with each method for a period of 2 min on a CO₂ producing mannequin. Participants were video recorded to determine the amount of effective ventilations delivered, and the overall percentage efficacy of each method. Informed consent was obtained.

Results 23 paediatric trainees provided a total of 6035 ventilations and 91.1% were deemed to be effective. There was no statistically significant difference between the percentage efficacy of breaths delivered between the three methods. Percentage of effective ventilations with ND, COD and CAP were 90.8%, 90.9% and 91.8% respectively. 15 (65%) of the trainees indicated a preference for the COD method and 8 (35%) for the CAP method. No trainees indicated a preference for the ND method. The CAP method was most likely to provide the highest efficacy per participant (47.8%).

Discussion Methods of CO₂ monitoring during manual ventilation with a facemask results in greater efficacy of delivered breaths. Whilst the NeoStat device was the preferred device by the majority of participants, the highest efficacy was achieved with the capnography device. Capnography may enhance facemask ventilation in the clinical setting and future trials are now required.