title: A Novel Prototype Neonatal Resuscitator That Controls Tidal Volume and Ventilation Rate: A Comparative Study of Mask Ventilation in a Newborn Manikin.
abstract: The objective of this randomized controlled manikin trial was to examine tidal volume (VT) delivery and ventilation rate during mask positive pressure ventilation (PPV) with five different devices, including a volume-controlled prototype Next Step™ device for neonatal resuscitation. We hypothesized that VTand rate would be closest to target with the Next Step™. Twenty-five Neonatal Resuscitation Program providers provided mask PPV to a newborn manikin (simulated weight 1 kg) in a randomized order with a self-inflating bag (SIB), a disposable T-piece, a non-disposable T-piece, a stand-alone resuscitation system T-piece, and the Next Step™. All T-pieces used a peak inflation pressure of 20 cmH2O and a positive end-expiratory pressure of 5 cmH2O. The participants were instructed to deliver a 5 mL/kg VT(rate 40-60/min) for 1 min with each device and each of three test lungs with increasing compliance of 0.5, 1.0, and 2.0 mL/cmH2O. VTand ventilation rate were compared between devices and compliance levels (linear mixed model). All devices, except the Next Step™ delivered a too high VT, up to sixfold the target at the 2.0-mL/cmH2O compliance. The Next Step™ VTwas 26% lower than the target in the low compliance. The ventilation rate was within target with the Next Step™ and SIB, and slightly lower with the T-pieces. In conclusion, routinely used newborn resuscitators over delivered VT, whereas the Next Step™ under delivered in the low compliant test lung. The SIB had higher VTand rate than the T-pieces. More research is needed on volume-controlled delivery room ventilation.
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada; Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Anne Lee
authors.initials: AL
authors.lastname: Solevåg
authors.affiliation: School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology , Auckland , New Zealand.
authors.forename: Enrico
authors.initials: E
authors.lastname: Haemmerle
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital , Edmonton, AB , Canada.
authors.forename: Sylvia
authors.initials: S
authors.lastname: van Os
authors.affiliation: Newborn Services, Auckland City Hospital , Auckland , New Zealand.
authors.forename: Katinka P
authors.initials: KP
authors.lastname: Bach
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada; Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Cheung
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada; Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
keywords: bronchopulmonary dysplasia; critical care; newborn; resuscitation; tidal volume; ventilation