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

OBJECTIVE

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 NextStepTM, a novel ventilation device designed for the delivery room.

METHODS

Prospective, randomized, crossover, simulation study. Following orientation to ventilation devices, participants were randomized to order of four ventilation devices (NextStepTM, 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) (NextStepTM 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 NextStepTM compared to the other devices.

RESULTS

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 NextStepTM [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 NextStepTM had less tidal volume variation compared to all other groups and peak inflation pressure was significantly lower with VTV-PPV with NextStepTM compared to all other groups.

CONCLUSION

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