Use of Respiratory Function Monitors during Simulated Neonatal Resuscitation

There is an international consensus statement as well as regional and national guidelines that provide advice on techniques and equipment used for neonatal resuscitation. Need for ventilation and evaluation of effectiveness should be done by clinical assessment of increase in the infants’ heart rate and chest wall rise. However,  studies have shown that assessment of face mask seal, tidal volume delivery and chest wall rise is limited and subjective.

In their review, Schmölzer and Roehr describe how a Respiratory Function Monitor (RFM) can aid simulation-based manikin training, including its capabilities and limitations. Furthermore, they demonstrate how a RFM can provide quantitative and qualitative assessment of the trainee’s resuscitation technique. They show that a RFM can assist to a) identify correct mask hold and positioning techniques; b) assess the delivered airway pressures and adjust the inflating pressures to deliver the appropriate tidal volume.

Schmölzer and colleague, highlight two limitations of RFM’s. The first, that the numerical value for mask leak is an averaged value from a certain time interval and therefore should not be used for evaluating or altering individual inflations. The second limitation relates to display of the numerical data and graphical curves which can aid the resuscitator, but they do not provide any interpretation of the signals.

Related to the clinical applicability of RFM at birth, the authors believe that a RFM can be an aid in training and neonatal resuscitations by adding objectivity to the patient assessment. In addition, they point out that recent studies have shown RFM usage have the potential to improve mask ventilation in the delivery room as well as mannequin teaching with RFM could improve individual staff competency during neonatal resuscitation.

Conclusion

They conclude by stating, ‘During simulated “ bag and mask ” ventilation a RFM can assist to identify correct mask hold and positioning techniques, to assess the provided PIP and PEEP, to adjust the PIP in order to deliver the appropriate VT, and to provide an objective and reproducible assessment of the trainee’s performance.’