Comparison of positive pressure ventilation devices in a newborn manikin

Abstract

Objective: To compare tidal volume (V_T) delivery and ventilation rate between devices for positive pressure ventilation (PPV) during newborn resuscitation.

Methods: Neonatal resuscitation program providers (n = 25) delivered PPV to a newborn manikin in a randomized order with: a self-inflating bag (SIB), a disposable T-piece, a non-disposable T-piece, a stand-alone infant resuscitation system T-piece and the volume-controlled prototype Next Step^TM device (KM Medical). All T-pieces used a peak inflation pressure of 20cmH₂O and a 5cmH₂O positive end-expiratory pressure (PEEP). The SIB neither had a PEEP valve nor manometer. The Next Step^TM had a 5cmH₂O PEEP valve. The participants aimed to deliver a 5 mL/kg V_T (rate 40–60 min⁻¹) for 1 min with each device and each of three compliances (0.5, 1.0 and 2.0 mL/cmH₂O). V_T and ventilation rate were compared between devices and compliance levels (ANOVA)

Results: All devices, except the Next Step^TM delivered a 4–5 mL/kg V_T at the low compliance, but three- to four-fold that of the target at the higher compliance levels. The Next Step^TM delivered a V_T close to target at all compliance levels. The ventilation rate was within 40–60 min⁻¹ with all devices and compliance levels.

Conclusions: Routinely used ventilation devices for newborn resuscitation can triple intended V_T and requires further investigation.

Keywords:

• Resuscitation
• tidal volume
• ventilation rate

Acknowledgements

We would like to thank the neonatal healthcare professionals who contributed to this study.

Declaration of interest

KM Medical provided ‘The Next Step™ Neonatal Resuscitator’ for the study. The company was involved in the design of the study, but not in the data acquisition, data analysis, interpretation of the results, or writing of the manuscript. Dr Haemmerle was in 2008 involved as a University of Auckland Senior Lecturer in the prototype design of the Next Step™ under a research and consultancy agreement between Auckland UniServices Limited and KM Medical (Auckland, NZ). The test lung was designed and manufactured by Auckland University of Technology under the supervision of Dr Haemmerle. Ms van Os and Drs Solevåg, Bach, Cheung and Schmölzer have no potential competing interest relevant to this article to disclose. ALS is supported by the Canadian Institutes of Health Research (operating grant MOP299116, held by PYC and travel award to ALS) and the South-Eastern Norway Regional Health Authority. GMS is supported by a Heart and Stroke Foundation/University of Alberta Professorship for Neonatal Resuscitation and by a Heart and Stroke Foundation of Canada Research Scholarship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.