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

Area of Science:

• Neonatal Resuscitation
• Pediatric Critical Care
• Respiratory Support Devices

Background:

• Positive pressure ventilation (PPV) is crucial in neonatal resuscitation.
• Optimizing mask seal and minimizing air leak are critical for effective PPV.
• Current methods like T-piece ventilation may have limitations in achieving consistent mask seal.

Purpose of the Study:

• To compare mask positive pressure ventilation (PPV) using ventilator-based volume-targeted ventilation (VTV) with devices like the NextStep™ and Draeger ventilator.
• To evaluate the efficacy of T-piece PPV with and without a respiratory function monitor (RFM).
• To determine the primary outcome of reduced mask leak with the NextStep™ device.

Main Methods:

• A prospective, randomized, crossover, simulation study was conducted.
• Participants were trained neonatal resuscitation providers randomized to four ventilation devices: NextStep™, Draeger ventilator, T-piece PPV with RFM visible, and T-piece PPV with RFM masked.
• The primary outcome measured was the reduction in mask leak.

Main Results:

• Volume-targeted ventilation (VTV-PPV) with the NextStep™ demonstrated significantly lower mask leak (6%) compared to the Draeger ventilator (24%), T-piece with RFM (18%), and T-piece without RFM (32%).
• Delivered tidal volume was comparable across groups, but NextStep™ showed less variation.
• Peak inflation pressure was significantly lower with VTV-PPV using the NextStep™.

Conclusions:

• In a neonatal manikin model, VTV-PPV with the NextStep™ device, utilizing a two-hand hold technique, effectively reduced mask leak.
• This suggests VTV-PPV with the NextStep™ is a promising alternative to T-piece ventilation for neonatal resuscitation.
• The NextStep™ device may improve ventilation delivery by minimizing mask leak.