The Next Step - a new device for mask ventilation in the Delivery Room

Mask ventilation remains the cornerstone of respiratory support in the delivery room. Pitfalls during mask ventilation are mask leak or airway obstruction, which could cause lower tidal volume delivery. In addition, operators generally sue a set pressure to deliver an adequate tidal volume. This adequate tidal volume delivery is judged by observing chest rise. However, the tidal volume is never measured.

We tested a prototype ventilation device “The Next Step” designed by KM Medical (http://www.kmmedical.co.nz).

The Next Step is an automatic, portable neonatal resuscitator and ventilator has been designed to reduce the incidence of volutrauma and barotraumas.

Here is the abstract for our first tests with the device, which are very promising.

Objective To compare tidal volume (VT) 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 StepTM device (KM Medical). All T-pieces used a peak inflation pressure of 20cmH2O and a 5cmH2O positive end-expiratory pressure (PEEP). The SIB neither had a PEEP valve nor manometer. The Next StepTM had a 5cmH2O PEEP valve. The participants aimed to deliver a 5mL/kg VT (rate 40-60min-1) for 1min with each device and each of three compliances (0.5, 1.0 and 2.0mL/cmH2O). VT and ventilation rate were compared between devices and compliance levels (ANOVA)

Results

All devices, except the Next StepTM delivered a 4-5mL/kg VT at the low compliance, but three- to four-fold that of the target at the higher compliance levels. The Next StepTM delivered a VT close to target at all compliance levels. The ventilation rate was within 40- 60min-1 with all devices and compliance levels.

Conclusions

Routinely used ventilation devices for newborn resuscitation can triple intended VT and requires further investigation.