Comparison of positive pressure ventilation devices in a newborn manikin.

Objective: To compare tidal volume (V) delivery and ventilation rate between devices for positive pressure ventilation (PPV) during newborn resuscitation.

Methods: Neonatal resuscitation program providers (n = 25) delivered PPV to a newborn manikin in a randomized order with: a self-inflating bag (SIB), a disposable T-piece, a non-disposable T-piece, a stand-alone infant resuscitation system T-piece and the volume-controlled prototype Next Step device (KM Medical). All T-pieces used a peak inflation pressure of 20cmHO and a 5cmHO positive end-expiratory pressure (PEEP). The SIB neither had a PEEP valve nor manometer. The Next Step had a 5cmHO PEEP valve. The participants aimed to deliver a 5 mL/kg V (rate 40-60 min) for 1 min with each device and each of three compliances (0.5, 1.0 and 2.0 mL/cmHO). V and ventilation rate were compared between devices and compliance levels (ANOVA) Results: All devices, except the Next Step delivered a 4-5 mL/kg V at the low compliance, but three- to four-fold that of the target at the higher compliance levels. The Next Step delivered a V close to target at all compliance levels. The ventilation rate was within 40-60 min with all devices and compliance levels.

Conclusions: Routinely used ventilation devices for newborn resuscitation can triple intended V and requires further investigation.