Comparison of Positive Pressure Ventilation Devices During Compliance Changes in a Neonatal Ovine Model

Overview

Journal Pediatr Res

Specialties Biology
Pediatrics

Date 2024 Jan 13

PMID 38218928

Authors

Kim Hoang Tran

Marwa Ramsie

Brenda Law

Georg Schmolzer

Affiliations

Soon will be listed here.

Abstract

Background: To compare tidal volume (V) delivery with compliance at 0.5 and 1.5 mL/cmHO using four different ventilation (PPV) devices (i.e., self-inflating bag (SIB), T-Piece resuscitator, Next Step (a novel Neonatal Resuscitator), and Fabian ventilator (conventional neonatal ventilator) using a neonatal piglet model.

Design/methods: Randomized experimental animal study using 10 mixed-breed neonatal piglets (1-3 days; 1.8-2.4 kg). Piglets were anesthetized, intubated, instrumented, and randomized to receive positive pressure ventilation (PPV) for one minute with a SIB with or without a respiratory function monitor (RFM), T-Piece resuscitator with or without an RFM, Next Step, and Fabian Ventilator with both compliance levels. Compliance changes were achieved by placing a wrap around the piglets' chest and tightened it. Our primary outcome was targeted V delivery of 5 mL/kg at 0.5 and 1.5 mL/cmHO lung compliance.

Results: At 0.5 mL/cmHO compliance, the mean(SD) expired V with the Next Step was 5.1(0.2) mL/kg compared to the Fabian 4.8(0.5) mL/kg, SIB 8.9(3.6) mL/kg, SIB + RFM 4.5(1.8) mL/kg, T-Piece 7.4(4.3) mL/kg, and T-Piece+RFM 6.4(3.1) mL/kg. At 1.5 mL/cmHO compliance, the mean(SD) expired V with the Next Step was 5.2(0.6) mL/kg compared to the Fabian 4.4(0.7) mL/kg, SIB 12.1(5.3) mL/kg, SIB + RFM 9.4(3.9) mL/kg, T-Piece 8.6(1.5) mL/kg, and T-Piece+RFM 6.5 (1.6) mL/kg.

Conclusion: The Next Step provides consistent V during PPV, which is comparable to a mechanical ventilator.

Impact: Current guidelines recommend fixed peak inflation pressure in resuscitation, linked to lung and brain injury. The Next Step Neonatal Resuscitator, a cost-effective device, offers volume-targeted positive pressure ventilation with consistent tidal volumes. With two different compliances, the Next Step Neonatal Resuscitator delivered a consistent tidal volume which was similar to a mechanical ventilator. The Next Step Neonatal Resuscitator outperformed self-inflating bags and T-Pieces in delivering targeted tidal volumes. The Next Step Neonatal Resuscitator could be an alternative ventilation device for neonatal resuscitation.

References

Aziz K, Chadwick M, Baker M, Andrews W . Ante- and intra-partum factors that predict increased need for neonatal resuscitation. Resuscitation. 2008; 79(3):444-52. DOI: 10.1016/j.resuscitation.2008.08.004. View

Schmolzer G, Te Pas A, Davis P, Morley C . Reducing lung injury during neonatal resuscitation of preterm infants. J Pediatr. 2008; 153(6):741-5. DOI: 10.1016/j.jpeds.2008.08.016. View

Schmolzer G, Kamlin O, ODonnell C, Dawson J, Morley C, Davis P . Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2010; 95(6):F393-7. DOI: 10.1136/adc.2009.174003. View

Dawson J, Schmolzer G, Kamlin C, Te Pas A, ODonnell C, Donath S . Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial. J Pediatr. 2011; 158(6):912-918.e1-2. DOI: 10.1016/j.jpeds.2010.12.003. View

Poulton D, Schmolzer G, Morley C, Davis P . Assessment of chest rise during mask ventilation of preterm infants in the delivery room. Resuscitation. 2010; 82(2):175-9. DOI: 10.1016/j.resuscitation.2010.10.012. View

Kaufman J, Schmolzer G, Kamlin C, Davis P . Mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2013; 98(5):F405-10. DOI: 10.1136/archdischild-2012-303313. View

Madar J, Roehr C, Ainsworth S, Ersdal H, Morley C, Rudiger M . European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation. 2021; 161:291-326. DOI: 10.1016/j.resuscitation.2021.02.014. View

Bjorklund L, Ingimarsson J, Curstedt T, John J, Robertson B, Werner O . Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res. 1997; 42(3):348-55. DOI: 10.1203/00006450-199709000-00016. View

Hernandez L, Peevy K, Moise A, Parker J . Chest wall restriction limits high airway pressure-induced lung injury in young rabbits. J Appl Physiol (1985). 1989; 66(5):2364-8. DOI: 10.1152/jappl.1989.66.5.2364. View

10.

Polglase G, Miller S, Barton S, Baburamani A, Wong F, Aridas J . Initiation of resuscitation with high tidal volumes causes cerebral hemodynamic disturbance, brain inflammation and injury in preterm lambs. PLoS One. 2012; 7(6):e39535. PMC: 3382197. DOI: 10.1371/journal.pone.0039535. View

11.

Mian Q, Cheung P, OReilly M, Barton S, Polglase G, Schmolzer G . Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2018; 104(1):F57-F62. DOI: 10.1136/archdischild-2017-313864. View

12.

Hooper S, Fouras A, Siew M, Wallace M, Kitchen M, Te Pas A . Expired CO2 levels indicate degree of lung aeration at birth. PLoS One. 2013; 8(8):e70895. PMC: 3741323. DOI: 10.1371/journal.pone.0070895. View

13.

Hooper S, Te Pas A, Kitchen M . Respiratory transition in the newborn: a three-phase process. Arch Dis Child Fetal Neonatal Ed. 2015; 101(3):F266-71. DOI: 10.1136/archdischild-2013-305704. View

14.

Schmolzer G, Kamlin O, Dawson J, Te Pas A, Morley C, Davis P . Respiratory monitoring of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2009; 95(4):F295-303. DOI: 10.1136/adc.2009.165878. View

15.

Bowman T, Paget-Brown A, Carroll J, Gurka M, Kattwinkel J . Sensing and responding to compliance changes during manual ventilation using a lung model: can we teach healthcare providers to improve?. J Pediatr. 2011; 160(3):372-376.e1. DOI: 10.1016/j.jpeds.2011.09.028. View

16.

Kattwinkel J, Stewart C, Walsh B, Gurka M, Paget-Brown A . Responding to compliance changes in a lung model during manual ventilation: perhaps volume, rather than pressure, should be displayed. Pediatrics. 2009; 123(3):e465-70. DOI: 10.1542/peds.2008-2012. View

17.

Schmolzer G, Morley C, Wong C, Dawson J, Kamlin C, Donath S . Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study. J Pediatr. 2011; 160(3):377-381.e2. DOI: 10.1016/j.jpeds.2011.09.017. View

18.

Gupta A, Keszler M . Survey of Ventilation Practices in the Neonatal Intensive Care Units of the United States and Canada: Use of Volume-Targeted Ventilation and Barriers to Its Use. Am J Perinatol. 2018; 36(5):484-489. DOI: 10.1055/s-0038-1669442. View

19.

Solevag A, Haemmerle E, van Os S, Bach K, Cheung P, Schmolzer G . A Novel Prototype Neonatal Resuscitator That Controls Tidal Volume and Ventilation Rate: A Comparative Study of Mask Ventilation in a Newborn Manikin. Front Pediatr. 2016; 4:129. PMC: 5124572. DOI: 10.3389/fped.2016.00129. View

20.

Solevag A, Haemmerle E, van Os S, Bach K, Cheung P, Schmolzer G . Comparison of positive pressure ventilation devices in a newborn manikin. J Matern Fetal Neonatal Med. 2016; 30(5):595-599. DOI: 10.1080/14767058.2016.1180360. View