Volume-Targeted Mask Ventilation During Simulated Neonatal Resuscitation: A Randomized Crossover Study

Delivering effective ventilation during neonatal resuscitation is one of the most critical—and technically challenging—skills in newborn care. Even for trained providers, achieving a good mask seal and consistent tidal volumes can be difficult, often resulting in excessive mask leak or variable pressures. To address this, our team compared traditional pressure-guided ventilation with two novel approaches that use automated, volume-targeted ventilation (VTV).

Study Overview

In this prospective, randomized crossover simulation study, experienced neonatal resuscitation providers performed positive pressure ventilation (PPV) using four different devices:

1. NextStep™ – a new, portable ventilator specifically designed for delivery room use.

2. VN500 Draeger Ventilator – a standard NICU ventilator capable of VTV.

3. T-Piece with Respiratory Function Monitor (RFM) visible.

4. T-Piece with RFM masked (standard practice).

Each participant performed PPV across four simulated neonatal scenarios in a dedicated resuscitation suite. The primary outcome was mask leak, with secondary outcomes including tidal volume stability and peak inflation pressure.

Key Findings

Thirty-two healthcare professionals participated, most of them neonatal resuscitation instructors or experienced team leaders. The results were clear:

• Mask leak was lowest when using the NextStep™ with VTV mode – a median of 6% (IQR 1–12%) – compared to 24% with the VN500 ventilator, 18% with the T-Piece and RFM visible, and 32% with the T-Piece and RFM masked.

• Tidal volumes were similar across all devices, but the NextStep™ achieved more consistent delivery with less variation between inflations.

• Peak inflation pressures were also lower with the NextStep™, indicating more efficient ventilation with less risk of barotrauma.

Why It Matters

Mask ventilation remains the cornerstone of neonatal resuscitation, yet it is prone to high variability. Volume-targeted ventilation (VTV) aims to deliver a set tidal volume automatically—helping ensure adequate ventilation while reducing pressure and leak variability.

This study shows that semi-automated, VTV-based mask PPV using the NextStep™ device significantly improves mask seal and reduces variability, even in the hands of experienced providers. The technology’s intuitive interface and automatic leak compensation could make it a valuable addition to delivery room resuscitation.

The Next Step Forward

While this was a simulation study, these findings lay the groundwork for clinical studies assessing VTV-based mask ventilation in real newborns. If similar benefits are observed in clinical practice, devices like the NextStep™ could represent an important evolution in how we support the first breaths of life—helping clinicians deliver more consistent, gentle, and effective ventilation right from birth.