在模拟新生儿复苏过程中，以容积为目标的面罩通气——一项随机交叉人体模型研究

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-09-23 DOI:10.1016/j.resplu.2025.101109

Chelsea Morin , Kashmala Yousafzai , Brenda Hiu Yan Law , Georg M. Schmölzer

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引用次数: 0

摘要

目的比较有或无呼吸功能监测仪（RFM）的压力引导装置（即T-Piece）提供的面罩正压通气（PPV）与使用VN500 Draeger呼吸机或为产房设计的新型通气装置NextStepTM的基于呼吸机的容积定向通气（VTV）。方法前瞻性、随机、交叉、模拟研究。在对通风设备进行定向后，参与者被随机分配到四种通风设备（NextStepTM、VN500 Draeger呼吸机、可见RFM的t片式PPV和屏蔽RFM的t片式PPV）的顺序和四种模拟场景的顺序。研究是在三级新生儿重症监护病房的新生儿复苏室进行的。参与者接受过新生儿复苏提供者或具有团队领导经验的指导员的培训。将半自动、基于呼吸机的容积定向面罩PPV (VTV-PPV) （NextStepTM或Draeger呼吸机）与通过t型装置（RFM可见或遮罩）进行的手动PPV进行比较。主要结果是与其他设备相比，NextStepTM减少了掩膜泄漏。结果32名医护人员参与调查，其中女性25人（78.1%），男性7人（21.9%）。与Draeger呼吸机[24 (25-38)%,p = 0.01]，带RFM的T-Piece [18 (9-33)%, p = 0.0088]和不带RFM的T-Piece [32 (12-57)%, p = >；0.0001]相比，带NextStepTM的VTV-PPV的面罩泄漏中位数（四分位数范围）显著降低[6(1-12)%]。虽然与其他所有组相比，NextStepTM的潮汐量变化较小，并且与所有其他组相比，使用NextStepTM的VTV-PPV的峰值通货膨胀压力显着降低，但两组之间的中位数（IQR）交付潮汐量没有差异。结论在新生儿模型中，与没有RFM引导的T-piece相比，使用双手握住的NextStepTM的VTV-PPV减少了面罩泄漏。

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Volume targeted mask ventilation during simulated neonatal resuscitation – A randomized crossover manikin study

Objective

To compare mask positive pressure ventilation (PPV) provided by pressure guided devices (i.e., T-Piece) with or without a respiratory function monitor (RFM) with ventilator-based volume-targeted ventilation (VTV) using a VN500 Draeger ventilator or the NextStep^TM, a novel ventilation device designed for the delivery room.

Methods

Prospective, randomized, crossover, simulation study. Following orientation to ventilation devices, participants were randomized to order of four ventilation devices (NextStep^TM, VN500 Draeger ventilator, T-piece PPV with RFM visible, and T-piece PPV with RFM masked) and order of four simulation scenarios. The study was performed in a neonatal resuscitation room within a level 3 neonatal intensive care unit. Participants were trained neonatal resuscitation providers or instructors with experience as team leader. Semi-automated, ventilator-based volume-targeted mask PPV (VTV-PPV) (NextStep^TM or Draeger Ventilator) was compared to manual PPV via a T-piece device (RFM either visible or masked). Primary outcome was reduction in mask leak with the NextStep^TM compared to the other devices.

Results

Thirty-two healthcare professionals [25 (78.1 %) were female and 7 (21.9 %) were male] participated. The median (interquartile range) mask leak was significantly lower with VTV-PPV with NextStep^TM [6 (1–12) %] compared to the Draeger Ventilator [24 (25–38)%, p = 0.01], T-Piece with RFM [18 (9–33) %, p = 0.0088], and T-Piece without RFM [32 (12–57)%, p = >0.0001]. The median (IQR) delivered tidal volume was not different between groups, although the NextStep^TM had less tidal volume variation compared to all other groups and peak inflation pressure was significantly lower with VTV-PPV with NextStep^TM compared to all other groups.