Background Positive pressure ventilation (PPV) in the delivery room is routinely performed using a face mask attached to a ventilation device. In 2023, the Consensus of Science and Treatment Recommendations for neonatal resuscitation stated that a supraglottic airway (SGA) can be used for PPV if resources and training permits. However, there is very limited data on tidal volume (VT) delivery using SGAs. We aimed to compare VT delivery using five ventilation devices (i.e., self-inflating bag (SIB)), T-Piece resuscitator, flow-inflating bag (FIB), NextStepTM, and Fabian ventilator with an SGA at two compliance levels using a neonatal piglet model. Design/methods Randomized crossover experimental animal trial using 10 mixed-breed neonatal piglets (1–3 days; 1.8–2.4 kg). Piglets were anesthetized, SGA placed, instrumented, and randomized to PPV for one minute with SIB with or without a respiratory function monitor (RFM), T-Piece resuscitator ± RFM, FIB ± RFM, NextStepTM, and Fabian Ventilator at two compliance levels. Compliance changes were achieved by placing a wrap around the piglets’ chest and tightening it. Our primary outcome was targeted VT delivery of 5 mL/kg at 0.5 and 1.5 mL/cmH2O lung compliance. Results At 0.5 mL/cmH2O compliance, mean(SD) expired VT with the NextStepTM was 5.0(0.1)mL/kg compared to Fabian 5.1(0.2), SIB 6.3(1.8), SIB + RFM 5.3(0.8), T-Piece 5.9(1.5), T-Piece+RFM 5.5(0.6), FIB 7.7(1.8), FIB + RFM 8.5(2.9)mL/kg. At 1.5 mL/cmH2O compliance, mean(SD) expired VT with the NextStepTM was 5.1(0.2)mL/kg compared to Fabian 5.1(0.2),SIB 11.6(3.4), SIB + RFM 7.1(1.8), T-Piece 9.8(1.8), T-Piece+RFM 7.9(1.3), FIB 12.6(3.2), FIB + RFM 9.2(1.4)mL/kg. Conclusion The NextStepTM provides consistent VT during PPV with little variation despite compliance changes. Clinical studies are warranted. Impact <UnorderedList Mark="Bullet"> <ItemContent> Current guidelines recommend fixed peak inflation pressure in resuscitation, linked to lung and brain injury. </ItemContent> <ItemContent> The NextStepTM Neonatal Resuscitator, a cost-effective device, offers volume-targeted positive pressure ventilation with consistent tidal volumes delivery. </ItemContent> <ItemContent> With two different compliances, the NextStepTM Neonatal Resuscitator delivered a consistent tidal volume similar to a mechanical ventilator. </ItemContent> <ItemContent> The NextStepTM Neonatal Resuscitator outperformed self-inflating or flow-inflating bags and T-Piece resuscitators to deliver targeted tidal volumes. </ItemContent> <ItemContent> The NextStepTM Neonatal Resuscitator could be an alternative ventilation device for neonatal resuscitation. </ItemContent> </UnorderedList>

Supraglottic airway in neonatal porcine model

期刊论文
发表日期：

2025年1月21日

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Rachel N. Gibbs,
Marwa Ramsie,
Megan O’Reilly,
Tze-Fun Lee,
Georg M. Schmölzer

摘要

Background

Positive pressure ventilation (PPV) in the delivery room is routinely performed using a face mask attached to a ventilation device. In 2023, the Consensus of Science and Treatment Recommendations for neonatal resuscitation stated that a supraglottic airway (SGA) can be used for PPV if resources and training permits. However, there is very limited data on tidal volume (V_T) delivery using SGAs. We aimed to compare V_T delivery using five ventilation devices (i.e., self-inflating bag (SIB)), T-Piece resuscitator, flow-inflating bag (FIB), NextStep^TM, and Fabian ventilator with an SGA at two compliance levels using a neonatal piglet model.

Design/methods

Randomized crossover experimental animal trial using 10 mixed-breed neonatal piglets (1–3 days; 1.8–2.4 kg). Piglets were anesthetized, SGA placed, instrumented, and randomized to PPV for one minute with SIB with or without a respiratory function monitor (RFM), T-Piece resuscitator ± RFM, FIB ± RFM, NextStep^TM, and Fabian Ventilator at two compliance levels. Compliance changes were achieved by placing a wrap around the piglets’ chest and tightening it. Our primary outcome was targeted V_T delivery of 5 mL/kg at 0.5 and 1.5 mL/cmH₂O lung compliance.

Results

At 0.5 mL/cmH₂O compliance, mean(SD) expired V_T with the NextStep^TM was 5.0(0.1)mL/kg compared to Fabian 5.1(0.2), SIB 6.3(1.8), SIB + RFM 5.3(0.8), T-Piece 5.9(1.5), T-Piece+RFM 5.5(0.6), FIB 7.7(1.8), FIB + RFM 8.5(2.9)mL/kg. At 1.5 mL/cmH₂O compliance, mean(SD) expired V_T with the NextStep^TM was 5.1(0.2)mL/kg compared to Fabian 5.1(0.2),SIB 11.6(3.4), SIB + RFM 7.1(1.8), T-Piece 9.8(1.8), T-Piece+RFM 7.9(1.3), FIB 12.6(3.2), FIB + RFM 9.2(1.4)mL/kg.

Conclusion

The NextStep^TM provides consistent V_T during PPV with little variation despite compliance changes. Clinical studies are warranted.

Impact

Current guidelines recommend fixed peak inflation pressure in resuscitation, linked to lung and brain injury.

The NextStep^TM Neonatal Resuscitator, a cost-effective device, offers volume-targeted positive pressure ventilation with consistent tidal volumes delivery.

With two different compliances, the NextStep^TM Neonatal Resuscitator delivered a consistent tidal volume similar to a mechanical ventilator.

The NextStep^TM Neonatal Resuscitator outperformed self-inflating or flow-inflating bags and T-Piece resuscitators to deliver targeted tidal volumes.

The NextStep^TM Neonatal Resuscitator could be an alternative ventilation device for neonatal resuscitation.