Respiratory function monitoring during neonatal resuscitation: A systematic review

Fuerch, Janene H.; Thió, Marta; Liley, Helen; Wyckoff, Myra H.; Rabi, Yacov

doi:10.1016/j.resplu.2022.100327

Cited by 14 publications

(14 citation statements)

References 37 publications

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“…The limitations of this study are as follows: (1) generalisation to human studies may not show similar findings, more research is required to demonstrate the value of RFMs in training staff; (2) no subjects were in the ‘first responder’ experience level, we speculate a greater benefit with first responder use; (3) no user adjustments of PIP when using TPR to increase tidal volumes (figure 2) leading to low values, whereas with SIB the volume was adjusted dynamically by squeeze distance. Contributing to this could have also been the lung compliance of the manikins used not being anatomically correct 4 22. It was not possible to tell if subjects used the tidal volume icon range or displayed volume as we did not use video recordings.…”

Section: Discussionmentioning

confidence: 99%

“…The Juno is a lightweight (85 g), inline, battery-driven (run-time 5 hours) RFM. The Juno monitor studied was a pre-commercial prototype (SW V.0.2.4) displaying: mask leak grouped by a traffic light LED panel (green reflecting leak from 0% to 29.9%, orange 30% to 59.9% and red ≥60% to 100%) with ranges based on leak significance reported in previous studies2 4 13; deflation tidal volume in millilitres as well as baby range icons (small 2.5–9.9 mL, medium 10–24.9 mL and large 25–50 mL) estimated based on resuscitation guidelines and inflation rate per minute 14. Displayed data is updated for each inflation in real time.…”

Section: Methodsmentioning

confidence: 99%

“…Respiratory function monitors (RFMs) have been used in many manikins and human infant studies to quantitate mask seal as a prerequisite to appropriate delivered tidal volumes 4 5. Most studies have used either commercial (Philips NM3, Acutronic Florian) or research RFMs that inform current guidelines on RFM use during newborn resuscitation 6–10.…”

Section: Introductionmentioning

confidence: 99%

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Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins

Tracy,

Hinder,

Morakeas

et al. 2024

Arch Dis Child Fetal Neonatal Ed

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BackgroundRespiratory function monitors (RFMs) have been used extensively in manikin and infant studies yet have not become the standard of training. We report the outcomes of a new portable, lightweight RFM, the Juno, designed to show mask leak and deflation tidal volume to assist in positive pressure ventilation (PPV) competency training using manikins.MethodsTwo leak-free manikins (preterm and term) were used. Participants provided PPV to manikins using two randomised devices, self-inflating bag (SIB) and T-piece resuscitator (TPR), with Juno display initially blinded then unblinded in four 90 s paired sequences, aiming for adequate chest wall rise and target minimal mask leak with appropriate target delivered volume when using the monitor.Results49 experienced neonatal staff delivered 15 569 inflations to the term manikin and 14 580 inflations to the preterm. Comparing blinded to unblinded RFM display, there were significant reductions in all groups in the number of inflations out of target range volumes (preterm: SIB 22.6–6.6%, TPR 7.1–4.2% and term: SIB 54.8–37.8%, TPR 67.2–63.8%). The percentage of mask leak inflations >60% was reduced in preterm: SIB 20.7–7.2%, TPR 23.4–7.4% and in term: SIB 8.7–3.6%, TPR 23.5–6.2%).ConclusionsUsing the Juno monitor during simulated resuscitation significantly improved mask leak and delivered ventilation among otherwise experienced staff using preterm and term manikins. The Juno is a novel RFM that may assist in teaching and self-assessment of resuscitation PPV technique.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins

Tracy,

Hinder,

Morakeas

et al. 2024

Arch Dis Child Fetal Neonatal Ed

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“…Current ILCOR consensus on the use of RFM is based on devices not commercially available, 4 8 20 and are complex systems with GUI’s more suited to ICU and anesthetic domains than birthing environments where unexpected resuscitation is common. First responders have less experience than neonatal staff who may take valuable minutes to arrive on the scene.…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory function monitors have been used in many manikin and human infant studies to quantitate mask seal as a prerequisite to appropriate delivered tidal volumes. 4 5 Most studies have used either the commercial Philips NM3 or the Acutronics Florian RFM or research RFMs that inform current guidelines on RFM use during newborn resuscitation. 6-10 They are expensive, heavy and complex monitors that require expert knowledge to use and are no longer commercially available.…”

Section: Introductionmentioning

confidence: 99%

Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins

Tracy,

Hinder,

Morakeas

et al. 2023

Preprint

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BackgroundRespiratory function monitors (RFM) have been used extensively in manikin and infant studies yet have not become the standard of training. We report the outcomes of a new portable, lightweight resuscitation monitor (Juno) designed to show mask leak and deflation tidal volume to assist in positive pressure ventilation (PPV) competency training using manikins.MethodsTwo leak-free manikins (Preterm and Term) were used. Participants provided positive pressure ventilation to manikins using two randomized devices self-inflating bag (SIB) and T-piece resuscitator (TPR) with Juno display initially blinded then unblinded in four 90-second paired sequences, aiming for adequate chest wall rise and target minimal mask leak with appropriate target delivered volume when using the monitor.Results49 experienced neonatal staff delivered 15,569 inflations to the term manikin and 14,580 inflations to the preterm. Comparing blinded to unblinded RFM display there were significant reductions in all groups in the number of inflations out of target range volumes (Preterm: SIB 22.6% to 6.6%, TPR: 7.1% to 4.2% and Term: SIB 54.8% to 37.8%, TPR 67.2 to 63.8%). The percentage of mask leak inflations >60% was reduced in Preterm: SIB 20.7% to 7.2%, TPR 23.4% to 7.4% and in Term: SIB 8.7% to 3.6%, TPR 23.5% to 6.2%).ConclusionsUsing the Juno monitor during simulated resuscitation significantly improved mask leak and delivered ventilation amongst otherwise experienced staff, using both preterm and term manikins. The Juno is a novel RFM that may assist in teaching and self-assessment of resuscitation technique.Key messagesWhat is already known on this topicMask leak is common, can be large in magnitude and produce ineffective ventilation.Excessive tidal volumes may injure vulnerable preterm lungs and brain.The optimum use of RFMs used in manikin training is not determined.What this study addsMask leaks in excess of 60 % significantly reduces delivered tidal volumes.Optimising mask seal reduces high leak inflations in manikin models.Optimising mask seal alone with TPR improves targeted volume delivery in manikin models.How this study might affect research, practice or policyInline RFM monitors with simple GUI can improve the delivery of resuscitation training at all levels of skill.Further research to guide policy how often to train to retain skills is needed.Further research will determine the effectiveness of this RFM as a tool for self-directed learning in rural or remote settings.

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Advantages of a Data-Capture System with Video to Record Neonatal Resuscitation Interventions

Trulsen,

Anumula,

Morales

et al. 2024

The Journal of Pediatrics

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Respiratory function monitoring during neonatal resuscitation: A systematic review

Cited by 14 publications

References 37 publications

Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins

Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins

Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins

Advantages of a Data-Capture System with Video to Record Neonatal Resuscitation Interventions

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