Volume targeted mask ventilation during simulated neonatal resuscitation - A randomized crossover manikin study

To compare mask positive pressure ventilation (PPV) provided by pressure guided devices (i.e., T-Piece) with or without a respiratory function monitor (RFM) with ventilator-based volume-targeted ventilation (VTV) using a VN500 Draeger ventilator or the NextStep^TM, a novel ventilation device designed for the delivery room.

Prospective, randomized, crossover, simulation study. Following orientation to ventilation devices, participants were randomized to order of four ventilation devices (NextStep^TM, VN500 Draeger ventilator, T-piece PPV with RFM visible, and T-piece PPV with RFM masked) and order of four simulation scenarios. The study was performed in a neonatal resuscitation room within a level 3 neonatal intensive care unit. Participants were trained neonatal resuscitation providers or instructors with experience as team leader. Semi-automated, ventilator-based volume-targeted mask PPV (VTV-PPV) (NextStep^TM or Draeger Ventilator) was compared to manual PPV via a T-piece device (RFM either visible or masked). Primary outcome was reduction in mask leak with the NextStep^TM compared to the other devices.

Thirty-two healthcare professionals [25 (78.1 %) were female and 7 (21.9 %) were male] participated. The median (interquartile range) mask leak was significantly lower with VTV-PPV with NextStep^TM [6 (1-12) %] compared to the Draeger Ventilator [24 (25-38)%, p = 0.01], T-Piece with RFM [18 (9-33) %, p = 0.0088], and T-Piece without RFM [32 (12-57)%, p = >0.0001]. The median (IQR) delivered tidal volume was not different between groups, although the NextStep^TM had less tidal volume variation compared to all other groups and peak inflation pressure was significantly lower with VTV-PPV with NextStep^TM compared to all other groups.

In a neonatal manikin model, VTV-PPV with the NextStep^TM using a two-hand hold reduced mask leak compared to the T-piece without RFM guidance.