657 - Optimization of ventilation strategies in preterm and term infants in a single-center intervention study

Previous studies on the benefit of the application of a respiratory function monitor (RFM) in the clinical setting rendered contradictory results. We hypothesized that this is based on differences in patient collectives, a specific learning effect due to patient rather than provider randomization as well as monitor design and training in monitor use.


Objective:

The current study was aimed at contributing to this debate by including a broad patient collective (term and preterm infants, varying gestational ages, weights, and comorbidities) as well as reducing potential learning effects by choosing a non-randomized study approach. Furthermore, a RFM with a simplified monitor design was used.


Design/Methods:

This study was designed as a non-randomized, non-blinded interventional trial in a tertiary Neonatal Intensive Care Unit and delivery room at the Medical University of Vienna.

Physicians performed positive pressure ventilations (PPV) based on patients’ clinical indication. PPV were either recorded with a hidden RFM (control group) or the RFM was visible to physicians and provided real-time feedback on ventilation quality (intervention group). The primary outcome was the percentage of ventilations with tidal volumes within a target range of 4-8 ml/kg. Secondary outcomes included mask leak, peak inspiratory pressure, ventilation rate, post end expiratory pressure, demographic data, as well as patient outcome data.


Results:

A total of 93 preterm and term born neonatal patients were included in this trial. The primary outcome was significantly higher in the intervention group with a visible RFM (53.2%) than in the control group without the feedback monitor (35.8%); (p < 0.001, 95% CI [-0.26 – -0.08]). Excessive tidal volumes (defined as > 8 ml/kg), which have been previously associated with an increased risk of brain injury, could be significantly reduced when the RFM was visible during ventilations (10% [SD 25] of ventilations in the intervention group vs. 29% [SD 35] of ventilations in control group; p = 0.004). Furthermore, mask leak could be significantly decreased with the use of the RFM (51.6% vs. 38.6%; p = 0.007).


Conclusion(s):

Our results suggest that the application of a RFM at the Neonatal Intensive Care Unit and in the delivery room leads to a significantly higher quality of ventilations (measured as higher percentage of tidal volumes within target range). We hypothesize, based on previous literature, that this increase in ventilation quality will also improve patient outcomes. Therefore, in a next step, we intend to analyze patient outcomes – data should be available at time of the conference.