Novel Neonatal Simulator Provides High-Fidelity Ventilation Training Comparable to Real-Life Newborn Ventilation.

Joanna Haynes,Øystein Gomo,Siren Rettedal,Peder Bjorland,Anastasia Ushakova,Jeffrey Perlman,Hege Ersdal

doi:10.3390/children8100940

Abstract

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.

Highlights

The need for neonatal resuscitation is ubiquitous and often unpredictable
By comparing ventilation parameters and their inter-relationships, along with the occurrence of upper airway obstruction between the manikin and real resuscitations, we aim to demonstrate the functional fidelity of this new simulator
All healthcare personnel (HCP) receive neonatal resuscitation training according to national resuscitation guidelines

Summary

Introduction

The need for neonatal resuscitation is ubiquitous and often unpredictable. Positive pressure ventilation (PPV) of the non-breathing newborn is the cornerstone of resuscitation. In-situ simulation training is widely used to prepare healthcare personnel (HCP) to manage this stressful and time-critical event. Simulation training has shown the potential to change clinical management of babies; data to support improved outcomes are limited [1]. PPV is a seemingly simple intervention, which belies the complex interplay of elements necessary for success. Fundamental to ventilation in the non-breathing newborn is the establishment of functional residual capacity (FRC). That can usually be achieved by PPV coupled with positive end-expiratory pressure (PEEP). Mitigating factors that may influence establishing FRC include mask leak and obstruction of the upper airways

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