Monitoring respiratory mechanics as a training tool for manual ventilation

Area of Science:

• Neonatal Resuscitation
• Pediatric Critical Care
• Medical Simulation and Training

Background:

• Manual ventilation is critical for neonatal resuscitation, yet achieving optimal tidal volume and minimizing mask leaks are persistent challenges.
• Approximately 500,000 newborns in Brazil annually require respiratory support, highlighting the need for effective resuscitation techniques.
• Respiratory Function Monitors (RFMs) offer real-time feedback that may improve manual ventilation skills.

Purpose of the Study:

• To evaluate the impact of RFM use on neonatology residents' manual ventilation skills.
• To assess the effectiveness of RFM feedback in optimizing tidal volume delivery and reducing mask leakage during neonatal resuscitation.
• To determine the long-term retention of improved ventilation skills after RFM-based training.

Main Methods:

• A prospective experimental study involving 23 neonatology residents using a neonatal manikin.
• Participants underwent five ventilation sessions: baseline, RFM feedback, immediately post-training, and at one and three months follow-up.
• Tidal volume and mask leakage were measured using a computerized system; data were analyzed with mixed linear models.

Main Results:

• RFM-based training significantly reduced excessive tidal volume at baseline (10.43 ml/kg) to lung-protective levels (4-6 ml/kg) across all post-training sessions (p < 0.001).
• Mask leakage consistently exceeded the recommended 20% threshold throughout all ventilation sessions and with both self-inflating bags and T-piece resuscitators.
• Improved tidal volume control was maintained at the three-month follow-up, demonstrating skill retention.

Conclusions:

• RFM-based training effectively enhances tidal volume control in neonatology residents, promoting lung-protective ventilation strategies.
• Persistent high mask leakage indicates a need for specific training in mask application and sealing techniques.
• RFMs demonstrate significant educational value in neonatal resuscitation training, with sustained improvements in ventilation performance.