Gibbs Rachel N, Ramsie Marwa, O'Reilly Megan, Lee Tze-Fun, Schmölzer Georg M
Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Pediatr Res. 2025 Jan 21. doi: 10.1038/s41390-025-03879-4.
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) delivery using SGAs. We aimed to compare V delivery using five ventilation devices (i.e., self-inflating bag (SIB)), T-Piece resuscitator, flow-inflating bag (FIB), NextStep, 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, 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 delivery of 5 mL/kg at 0.5 and 1.5 mL/cmHO lung compliance.
At 0.5 mL/cmHO compliance, mean(SD) expired V with the NextStep 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/cmHO compliance, mean(SD) expired V with the NextStep 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.
The NextStep provides consistent V during PPV with little variation despite compliance changes. Clinical studies are warranted.
Current guidelines recommend fixed peak inflation pressure in resuscitation, linked to lung and brain injury. The NextStep Neonatal Resuscitator, a cost-effective device, offers volume-targeted positive pressure ventilation with consistent tidal volumes delivery. With two different compliances, the NextStep Neonatal Resuscitator delivered a consistent tidal volume similar to a mechanical ventilator. The NextStep Neonatal Resuscitator outperformed self-inflating or flow-inflating bags and T-Piece resuscitators to deliver targeted tidal volumes. The NextStep Neonatal Resuscitator could be an alternative ventilation device for neonatal resuscitation.
产房内的正压通气（PPV）通常使用连接到通气设备的面罩进行。2023年，新生儿复苏的科学与治疗建议共识指出，如果资源和培训允许，声门上气道（SGA）可用于PPV。然而，关于使用SGA输送潮气量（V）的数据非常有限。我们旨在使用新生仔猪模型，比较五种通气设备（即自动充气式气囊（SIB）、T形管复苏器、流量充气式气囊（FIB）、NextStep和Fabian呼吸机）在两种顺应性水平下使用SGA时的V输送情况。
设计/方法：采用随机交叉实验动物试验，使用10只杂种新生仔猪（1 - 3日龄；体重1.8 - 2.4千克）。仔猪麻醉后，放置SGA，进行仪器安装，并随机分配接受PPV 1分钟，分别使用带或不带呼吸功能监测器（RFM）的SIB、T形管复苏器±RFM、FIB±RFM、NextStep和Fabian呼吸机，设置两种顺应性水平。通过在仔猪胸部缠绕并收紧包裹物来实现顺应性变化。我们的主要结局指标是在肺顺应性为0.5和1.5 mL/cmH₂O时，目标V输送量为5 mL/kg。
在顺应性为0.5 mL/cmH₂O时，NextStep的平均（标准差）呼出V为5.0（0.1）mL/kg，而Fabian为5.1（0.2）mL/kg，SIB为6.3（1.8）mL/kg，SIB + RFM为5.3（0.8）mL/kg，T形管为5.9（1.5）mL/kg，T形管+RFM为5.5（0.6）mL/kg，FIB为7.7（1.8）mL/kg，FIB + RFM为8.5（2.9）mL/kg。在顺应性为1.5 mL/cmH₂O时，NextStep的平均（标准差）呼出V为5.1（0.2）mL/kg，而Fabian为5.1（0.2）mL/kg，SIB为11.6（3.4）mL/kg，SIB + RFM为7.1（1.8）mL/kg，T形管为9.8（1.8）mL/kg，T形管+RFM为7.9（1.3）mL/kg，FIB为12.6（3.2）mL/kg，FIB + RFM为9.2（1.4）mL/kg。
NextStep在PPV期间提供一致的V，尽管顺应性发生变化，但变化很小。有必要进行临床研究。
当前指南建议在复苏中使用固定的峰值充气压力，这与肺和脑损伤有关。NextStep新生儿复苏器是一种经济高效的设备，可提供容量目标性正压通气，并能一致地输送潮气量。在两种不同的顺应性水平下，NextStep新生儿复苏器输送的潮气量与机械呼吸机相似且一致。NextStep新生儿复苏器在输送目标潮气量方面优于自动充气式或流量充气式气囊以及T形管复苏器。NextStep新生儿复苏器可能是新生儿复苏的一种替代通气设备。
