Using a Respiratory Function Monitor to Guide Supraglottic Airway Placement in Neonates: A Pilot Study

Background

Ensuring proper placement of a supraglottic airway device (SAD) in neonates during intensive care procedures is crucial for effective ventilation. This study explored whether using a respiratory function monitor (RFM) to guide SAD placement could reduce the number of attempts needed for successful positioning. We hypothesized that real-time feedback from the RFM would optimize placement by reducing leakage and improving ventilation quality.

Methods

This single-center pilot study was conducted in a tertiary neonatal intensive care unit (NICU) at the Medical University of Vienna. Neonates requiring ventilation via a SAD during neurosurgical or endoscopic procedures were included.

The study design involved two groups:

• Hidden RFM Group: The RFM was recording but not visible to providers during SAD placement.

• Visible RFM Group: The RFM was visible to providers, allowing real-time feedback to guide SAD positioning.

Correct placement was assessed using the leakage parameter recorded by the RFM. If leakage was below 30%, the SAD was considered correctly positioned. The primary outcome was the number of attempts required for successful placement. Secondary outcomes included ventilation parameters recorded by the RFM and the duration of SAD placement.

Results

Six neonates were included in this pilot trial. Key findings included:

• Reduction in Attempts: The median number of placement attempts was lower when the RFM was visible (3 attempts in the hidden group vs. 1 attempt in the visible group).

• Improved Ventilation Quality: Real-time RFM feedback allowed for necessary adjustments in SAD positioning, significantly reducing mean leakage (74.8% in the hidden group vs. 17.8% in the visible group).

• Confirmation of Proper Placement: Endoscopic verification confirmed that using the RFM to guide placement resulted in anatomically correct positioning of the SAD.

Conclusion

This pilot study suggests that an RFM can provide valuable feedback during SAD placement in neonates, improving the efficiency and accuracy of the procedure.

Impact Statement

Real-time feedback from an RFM correlated low leakage values with correct SAD positioning, potentially enhancing neonatal airway management. The use of RFM guidance may decrease procedural time, minimize repeated attempts, and improve ventilation quality. While these preliminary findings are promising, further research with larger sample sizes is needed to confirm these results and establish best practices for neonatal airway management.

Link to article: https://www.nature.com/articles/s41390-025-03810-x