Abstract
This study aimed to test the accuracy in volume measurements of three available respiratory function monitors (RFMs) for neonatal resuscitation and the effect of changing gas conditions. The Florian, New Life Box Neo-RSD (NLB Neo-RSD) and NICO RFM were tested on accuracy with volumes of 10 and 20 mL and on changes in volume measurements under changing gas conditions (oxygen level 21–100 % and from cold dry air (24 ± 2 °C) to heated humidified air (37 °C). Volume differences >10 % were considered clinically relevant. We found that the mean (SD) volume difference was clinically acceptable for all devices (10, 20 mL): Florian (+8.4 (1.2)%, +8.4 (0.5)%); NLB Neo-RSD (+5.8 (1.1)%, +4.3 (1.4)%); and NICO (−8.2 (0.9)%, −8.7 (0.8)%). Changing from cold dry to heated humidified air increased the volume difference using the Florian (cold dry air, heated humidified air (+5.2 (1.2)%, +12.2 (0.9)%) but not NLB Neo-RSD (+2.0(1.6)%, +3.4(2.8)%) and NICO (−2.3 % (0.8), +0.1 (0.6)%). Similarly, when using heated humidified air, increasing oxygen enlarged increased the volume difference using the Florian (oxygen 21 %, 100 %: +12.2(1.0)%, +19.8(1.1)%), but not NLB Neo-RSD (+0.2(1.9)%, +1.1(2.8)%) and NICO (−5.6(0.9)%, −3.7(0.9)%). Clinically relevant changes occurred when changing both gas conditions (Florian +25.7(1.7)%; NLB Neo-RSD +3.8(2.4)%; NICO −5.7(1.4)%).Conclusion: The available RFMs demonstrated clinically acceptable deviations in volume measurements, except for the Florian when changing gas conditions. What is known: •Respiratory function monitors (RFMs) are increasingly used for volume measurements during respiratory support of infants at birth. •During respiratory support at birth, gas conditions can change quickly, which can influence the volume measurements. What is new: •The available RFMs have clinically acceptable deviations when measuring the accuracy of volume measurements.•The RFM using a hot wire anemometer demonstrated clinically relevant deviations in volume measurements when changing the gas conditions. These deviations have to be taken into account when interpreting the volumes directly at birth.
Highlights
Adequate mask ventilation is the cornerstone of neonatal resuscitation at birth [1, 2]
While current guidelines do not recommend the use of a respiratory function monitor (RFM) during neonatal resuscitation at birth [6], it has been suggested that RFMs may improve mask ventilation, leak, and technique, and measuring tidal volumes has the potential to decrease lung injury [2, 7,8,9,10,11,12]
Three types of RFMs are available for measuring lung function at birth using different techniques to measure gas flow and software for calculations of the tidal volume
Summary
Adequate mask ventilation is the cornerstone of neonatal resuscitation at birth [1, 2]. While current guidelines do not recommend the use of a respiratory function monitor (RFM) during neonatal resuscitation at birth [6], it has been suggested that RFMs may improve mask ventilation, leak, and technique, and measuring tidal volumes has the potential to decrease lung injury [2, 7,8,9,10,11,12]. A large multicentre randomized trial is currently being undertaken (monitor trial, trial number NTR4104) to investigate whether a RFM will improve the tidal ventilation given to preterm infants at birth. Three types of RFMs are available for measuring lung function at birth using different techniques to measure gas flow and software for calculations of the tidal volume. A newly developed resuscitation monitor is used with a built-in New Life Box Neo-RSD (NLB Neo-RSD, Advanced Life Diagnostics UG, Weener, Germany) for lung function measurements, using a differential pressure pneumotachometer with a variable orifice
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