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Comparison of positive pressure ventilation devices during compliance changes in a neonatal ovine model

Pediatric Research (2024)Cite this article

Abstract

Background

To compare tidal volume (VT) delivery with compliance at 0.5 and 1.5 mL/cmH2O 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 VT delivery of 5 mL/kg at 0.5 and 1.5 mL/cmH2O lung compliance.

Results

At 0.5 mL/cmH2O compliance, the mean(SD) expired VT 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/cmH2O compliance, the mean(SD) expired VT 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 VT 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.

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Fig. 1: Tidal volume delivery during positive pressure ventilation.

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Data availability

All data generated or analyzed during this study are included in this published article. Data used to generate the results reported in this study will be made available following publication to researchers who provide a methodologically sound proposal.

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Funding

We received funding from KM Medical, Auckland, New Zealand to perform the study. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. K.H.T. is a recipient of a Graduate Scholarship (University of Alberta), a Graduate Scholarship (University of Alberta Faculty of Medicine and Dentistry), a Canada Graduate Scholarships-Master’s program (Canadian Institutes of Health Research), and a Walter H Johns Graduate Fellowship (University of Alberta). M.R. is a recipient of a Graduate Scholarship (University of Alberta), a Graduate Scholarship (University of Alberta Faculty of Medicine and Dentistry), a Canada Graduate Scholarships-Master’s program (Canadian Institutes of Health Research), and a Walter H Johns Graduate Fellowship (University of Alberta). Conception and design: G.M.S., B.L.; Collection and assembly of data: G.M.S., B.L., M.R., K.T.; Analysis and interpretation of the data: G.M.S., B.L., M.R., K.T.; Drafting of the 1st draft: K.T.; Critical revision of the article for important intellectual content: G.M.S., B.L., M.R., K.T. Final approval of the article: G.M.S., B.L., M.R., K.T.

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Authors and Affiliations

  1. Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada

    Kim Hoang Tran, Marwa Ramsie, Brenda Law & Georg Schmölzer

  2. Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Kim Hoang Tran, Marwa Ramsie, Brenda Law & Georg Schmölzer

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  1. Kim Hoang Tran
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Correspondence to Georg Schmölzer.

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Tran, K.H., Ramsie, M., Law, B. et al. Comparison of positive pressure ventilation devices during compliance changes in a neonatal ovine model. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03028-3

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