Feasibility and Functional Evaluation of Noninvasive Ventilation Capable Equipment from the Delivery Room to Neonatal Intensive Care Unit: A Bench Study

Abstract

Objective: The use of noninvasive ventilation (NIV) for newborns requiring respiratory support in delivery room (DR) is recommended. However, the details related to such use are not well established. A bench investigation on the performance of available NIV equipment was conducted. Methods: Two T-piece resuscitators (TPRs) and three ventilators were tested with a Neonatal Lung Simulator which is capable of recording the pressure, flow, and volume. We measured the pressurization and delivered volume (DV) of nasal continuous positive airway pressure (nCPAP), bubble CPAP (bCPAP)/nasal high-frequency ventilation (nHFV), and synchronized nasal intermittent positive pressure ventilation (SNIPPV) in apneic and breathing models. Temperature and absolute humidity (AH) at the Y-piece were checked for 10 minutes in each setting while the Y-piece on an open bassinet or in a preheated incubator. Results: The pressurization was well achieved with every combination except for TPRs on nCPAP. DV was well provided using bCPAP/nHFV and SNIPPV in the breathing model. With bCPAP, DV decreased significantly in apneic model. On the bassinet, temperature and AH dropped to ambient temperature and approximately 25 mgH2O/L within 4 minutes, respectively. In the incubator, temperature and AH on all pre-humidified machines were maintained above 34°C and 30 mgH2O/L for 5 minutes, respectively. Those without pre-humidification were below 30°C and less than 20 mgH2O/L, respectively. Conclusion: Other combination of device/equipment than TPR tested seemed more feasible for nCPAP. The use of equipment with backup ventilation and heated-humidified gas in preheated incubators would be more appropriate NIV for premature infants in DR and during transport.