Volume-targeted mask ventilation during simulated neonatal resuscitation

Area of Science:

• Neonatal Resuscitation
• Pediatric Mechanical Ventilation
• Respiratory Support

Background:

• Mask positive pressure ventilation (PPV) in delivery rooms typically uses set peak inflation pressures.
• Stand-alone respiratory function monitors (RFMs) are used to aid mask PPV.
• Ventilator-based volume-targeted ventilation (VTV) is standard in neonatal intensive care units (NICUs).

Purpose of the Study:

• To compare ventilator-based volume-targeted mask ventilation (VTV-PPV) with T-piece PPV, with and without RFM guidance, in a neonatal simulation setting.
• To evaluate the effectiveness of VTV-PPV in reducing mask leak and ensuring consistent tidal volume delivery.

Main Methods:

• A prospective, randomized, crossover simulation study.
• Healthcare professionals (HCPs) trained in neonatal resuscitation performed mask ventilation on a manikin.
• Interventions included VTV-PPV, T-piece PPV with RFM visible, and T-piece PPV with RFM masked.

Main Results:

• Thirty-two HCPs participated in the simulation.
• VTV-PPV significantly reduced mask leak (11%) compared to T-piece methods (82% or 81%) (p<0.0001).
• Delivered tidal volume (V_T) was higher and more consistent with VTV-PPV (4.1 mL/kg) versus T-piece methods (2.1 mL/kg or 1.8 mL/kg) (p=0.0496). Peak inflation pressure (PIP) was also lower with VTV-PPV.

Conclusions:

• Ventilator-based VTV-PPV demonstrated superior performance in reducing mask leak during neonatal simulation.
• VTV-PPV facilitates consistent tidal volume delivery compared to traditional T-piece ventilation methods.
• This study suggests VTV-PPV is a promising approach for neonatal mask ventilation.