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Volume-targeted mask ventilation during simulated neonatal resuscitation

Abstract

Objective Mask positive pressure ventilation (PPV) in the delivery room is routinely delivered with set peak inflation pressures. To aid mask PPV, stand-alone respiratory function monitors (RFMs) have been used in the delivery room, while ventilator-based, volume-targeted ventilation (VTV) is routinely used in the neonatal intensive care unit (NICU).

Design This is a prospective, randomised, crossover simulation study. Participants were briefly trained to use a neonatal ventilator for volume-targeted mask ventilation (VTV-PPV), then performed mask ventilation on a manikin in a randomised order using VTV-PPV, T-piece PPV or T-piece PPV with RFM visible.

Setting In situ in a neonatal resuscitation room within a level 3 NICU.

Participants Healthcare professionals (HCPs) trained in neonatal resuscitation with experience as team leaders.

Interventions Semiautomated, ventilator-based VTV-PPV using two-hand hold versus manual PPV via a T-piece device (T-piece, RFM masked) versus manual PPV with RFM visible using one-hand hold.

Main outcome measures Respiratory characteristics including % mask leak, tidal volume (VT) and peak inflation pressure (PIP).

Results Thirty-two HCPs (23 (72%) female and 9 (28%) male) participated. The median mask leak was significantly lower with ‘VTV-PPV’ (11%, IQR 0%–14%) compared with both ‘T-piece, RFM visible’ (82%, IQR 30%–91%) and ‘T-piece, RFM masked’ (81%, IQR 47%–91%) (p<0.0001). The median delivered VT was 4.1 mL/kg (IQR 3.9–4.4) with VTV-PPV compared with 2.1 mL/kg (IQR 1.2–9) with T-piece, RFM visible and 1.8 mL/kg (IQR 1.1–5.8) with T-piece, RFM masked (p=0.0496). PIP was also significantly lower with VTV-PPV.

Conclusion During neonatal simulation, VTV-PPV reduced mask leak and allowed for consistent VT delivery compared with T-piece with and without RFM guidance.

  • Neonatology
  • Resuscitation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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