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Volume-targeted mask ventilation during simulated neonatal resuscitation

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 VTdelivery compared with T-piece with and without RFM guidance.

Arch Dis Child Fetal Neonatal Ed. 2023 Sep 29:fetalneonatal-2023-325902. doi: 10.1136/archdischild-2023-325902.


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