Use of a mechanical ventilator with respiratory function monitoring provides more consistent ventilation during simulated neonatal resuscitation

Abstract

Introduction: Positive pressure ventilation (PPV) with T-Piece and self-inflating bag (SIB) during neonatal resuscitation after birth is associated with variability in ventilation. The use of a ventilator with respiratory function monitoring (RFM) for PPV, however, has not been evaluated. Objective: To determine if ventilator + RFM can reduce ventilation variability compared to T-Piece and SIB in a preterm manikin at different combinations of target tidal volume (V T) and lung compliance (C L). Methods: Twenty clinicians provided PPV via mask and endotracheal tube (ETT) using SIB, T-Piece, T-Piece + RFM and Ventilator + RFM to a manikin with adjustable lung C L. Three combinations of C L and target V T : Low C L -Low V T, Low C L -High V T and High C L -Low V T were used in a random order. Results: The use of ventilator + RFM for PPV via ETT during High C L -Low V T period reduced the proportion of breaths with expiratory V T above target when compared to the other 3 devices (56 ± 35%, 85 ± 20%, 90 ± 25%, 92 ± 12% for ventilator + RFM, T-Piece + RFM, T-Piece, SIB, respectively; p < 0.05). During PPV via both mask and ETT, ventilator + RFM maintained the set Ti and rate, whereas SIB and T-Piece use resulted in higher rates, and T-Piece in higher proportion of breaths with prolonged Ti. During PPV via mask, ventilator + RFM reduced gas leakage compared to other devices. Conclusion: In this simulation study, use of a mechanical ventilator with RFM led to an overall improvement in volume targeting at different settings of C L and reduced the gas leak during mask ventilation. The efficacy and safety of using this strategy to neonatal resuscitation in the delivery room needs to be evaluated.