Supraglottic airway in neonatal porcine model

Positive pressure ventilation (PPV) in the delivery room is routinely performed using a face mask attached to a ventilation device. In 2023, the Consensus of Science and Treatment Recommendations for neonatal resuscitation stated that a supraglottic airway (SGA) can be used for PPV if resources and training permits. However, there is very limited data on tidal volume (V_T) delivery using SGAs. We aimed to compare V_T delivery using five ventilation devices (i.e., self-inflating bag (SIB)), T-Piece resuscitator, flow-inflating bag (FIB), NextStep^TM, and Fabian ventilator with an SGA at two compliance levels using a neonatal piglet model.

Randomized crossover experimental animal trial using 10 mixed-breed neonatal piglets (1-3 days; 1.8-2.4 kg). Piglets were anesthetized, SGA placed, instrumented, and randomized to PPV for one minute with SIB with or without a respiratory function monitor (RFM), T-Piece resuscitator ± RFM, FIB ± RFM, NextStep^TM, and Fabian Ventilator at two compliance levels. Compliance changes were achieved by placing a wrap around the piglets' chest and tightening it. Our primary outcome was targeted V_T delivery of 5 mL/kg at 0.5 and 1.5 mL/cmH₂O lung compliance.

At 0.5 mL/cmH₂O compliance, mean(SD) expired V_T with the NextStep^TM was 5.0(0.1)mL/kg compared to Fabian 5.1(0.2), SIB 6.3(1.8), SIB + RFM 5.3(0.8), T-Piece 5.9(1.5), T-Piece+RFM 5.5(0.6), FIB 7.7(1.8), FIB + RFM 8.5(2.9)mL/kg. At 1.5 mL/cmH₂O compliance, mean(SD) expired V_T with the NextStep^TM was 5.1(0.2)mL/kg compared to Fabian 5.1(0.2),SIB 11.6(3.4), SIB + RFM 7.1(1.8), T-Piece 9.8(1.8), T-Piece+RFM 7.9(1.3), FIB 12.6(3.2), FIB + RFM 9.2(1.4)mL/kg.

The NextStep^TM provides consistent V_T during PPV with little variation despite compliance changes. Clinical studies are warranted.

Current guidelines recommend fixed peak inflation pressure in resuscitation, linked to lung and brain injury. The NextStep^TM Neonatal Resuscitator, a cost-effective device, offers volume-targeted positive pressure ventilation with consistent tidal volumes delivery. With two different compliances, the NextStep^TM Neonatal Resuscitator delivered a consistent tidal volume similar to a mechanical ventilator. The NextStep^TM Neonatal Resuscitator outperformed self-inflating or flow-inflating bags and T-Piece resuscitators to deliver targeted tidal volumes. The NextStep^TM Neonatal Resuscitator could be an alternative ventilation device for neonatal resuscitation.