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

Abstract

ABSTRACTBackgroundRespiratory 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.