Massimo Micaglio

In a recent short-term physiological study, we demonstrated a new continuous positive airway pressure (CPAP) system (neonatal helmet-CPAP) that could be a feasible device for managing preterm infants needing continuous distending pressure with better tolerability than nasal-CPAP. However, its application for a long-term period has never been reported in neonates. Here, we describe the use of neonatal helmet-CPAP in a neonate with persistent pulmonary hypertension of the newborn. Twenty minutes after neonatal helmet-CPAP placement, the baseline post-ductal tcSaO2 (66%) and alveolar-arterial gradient O2 improved from 66% and 648 mmHg to 100% and 465 mmHg, respectively. The neonatal helmet-CPAP was applied for 48 hours and was well-tolerated by the patient without complications. Long-term use of neonatal helmet-CPAP appears feasible and well-tolerated. Comparative trials are needed.

When compared with the Classic™ laryngeal mask airway (cLMA), the recently introduced ProSeal™ laryngeal mask airway (PLMA) has modified features to produce higher airway seal pressures and enable ventilation in circumstances where the cLMA might fail. The first neonatal size 1 PLMA recently became available. This study was designed to compare the effectiveness of the size 1 cLMA and PLMA during positive pressure ventilation in anesthetized neonates and infants. Forty-six consecutive patients undergoing elective cardiac surgical procedures were randomized for initial airway management with the cLMA or PLMA. Insertion time (IT), number of placement attempts, ease of placement, quality of the initial airway, maximum tidal volume (TV_max), and airway pressure at which an audible leak in the mouth (P_leak) occurred were collected. All data were recorded before performing tracheal intubations. IT and success rate were similar for both LMAs. The initial quality of the airway was significantly better for the PLMA (Pmax and P_leak were significantly higher for PLMA (77 vs 58 ml, Pvs 24.4 cm H₂O, P<0.02). No adverse events were recorded during the study. The size 1 PLMA forms a more effective seal than size 1 cLMA in neonates. This might allow the PLMA to be used in those newborn infants requiring high airway pressures for ventilation.

Summary: Background : Neonatal resuscitation is a mandatory skill for healthcare professionals involved in maternity suites. For ethical reasons, it is impossible to teach and practice airway management skills on neonates, and manikins are used for this purpose. The Classic Laryngeal Mask Airway TM (cLMA) is accepted as an effective device for airway management during neonatal resuscitation. A neonatal size of the LMA‐ProSeal^TM (PLMA) was recently produced, but there are no comparative data on its performance. We describe the comparison of the performances of the neonatal cLMA and the neonatal PLMA when used by different healthcare professionals in a dedicated airway management manikin.Methods : Thirty‐five healthcare professionals, were given a brief description of the two devices followed by 15 min of supervised insertions on a single manikin. Every trainee was then instructed to insert both devices four times. The time from insertion to the first inflation of the artificial lungs (insertion time, IT) was recorded by a single unblinded observer.Results : No failed insertions were recorded. The success rates of the first attempt were higher with the PLMA than the cLMA (97.1% vs 92.1%; P < 0.01). The mean ± sd (range) IT was significantly lower with the cLMA compared with the PLMA [10.47 ± 2.85 (6–22) s vs 11.34 ± 2.5 (7–18) s; P < 0.01]. The mean ± sd (range) IT of the cLMA was 12.31 ± 3.54 (7–22) s for the first positioning and 9.2 ± 2.34 (6–16) s for the fourth (P < 0.01). The mean ± sd (range) IT of the PLMA was 12.71 ± 2.52 (8–18) s for the first positioning and 10.17 ± 2.28 (7–14) s for the fourth (P < 0.01). There were no significant differences among groups.Conclusions : Both LMAs are easy to insert by different delivery‐room workers. PLMA (with the introducer tool) has a higher success rate at first attempt than cLMA. Manikin ventilation was established equally without difference in performance among doctors, nurses, midwives. A brief manikin‐training reduces the IT significantly. The longer IT of PLMA vs cLMA is without clinical relevance.