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. 2025 Oct 15:26:101132.
doi: 10.1016/j.resplu.2025.101132. eCollection 2025 Nov.

Respiratory function monitors (RFMs) used for newborn resuscitation: accuracy and performance in the presence of leak. A bench comparison study

Stephanie Morakeas  1   2 , Viktoria Gruber  3   4 , Murray Hinder  5 , Thomas Drevhammar  6 , Alistair McEwan  2 , Mark Brian Tracy  1   3
Affiliations

Respiratory function monitors (RFMs) used for newborn resuscitation: accuracy and performance in the presence of leak. A bench comparison study

Stephanie Morakeas et al. Resusc Plus. .

Abstract

Background: Use of respiratory function monitors (RFMs) during newborn resuscitation is not currently recommended by ILCOR. New-generation compact monitors have recently entered the market with portable designs offering better integration into clinical practice. Consensus on science regarding RFM use has been gained using complex legacy or research-only devices. This study aims to compare the accuracy and performance under leak conditions of two legacy RFMs with two new-generation monitors.

Methods: The accuracy of new-generation RFMs (ResusRight-Juno, Monitvent-Neo100) were compared to legacy RFMs (Acutronics-Florian, Phillips-NM3) in the presence of imposed dynamic leaks (0 %, 20 %, 50 %, 90 %). Manual inflations using a Self-inflating bag (SIB) and T-piece Resuscitator (TPR) were delivered to a test lung (compliance 0.6 and 2 mL/cmH2O). Tidal volume, leak and pressure were measured proximal to leak by each RFM and related to traceable reference values.

Results: Analysis of 1,920 inflations was performed. At zero leak, all RFMs performed with comparable accuracy for tidal volume, leak and pressure with minimal differences to reference measurements. System leak was accurately determined with tested RFMs at all levels. At 90 % system leak, RFM measured SIB-delivered volumes decreased significantly to <50 % compared with no leak; TPR-delivered volumes were less impacted and more accurate.

Conclusion: The new-generation RFMs demonstrated comparable accuracy and performance to legacy devices at zero leak. All RFMs displayed accurate leak levels including 90 %. RFMs used with SIBs showed significantly reduced performance and accuracy at 90 % leak in contrast to TPR at 90% leak. New-generation RFMs simplified user interfaces may enhance benefits during clinical use.

Keywords: Leak; Newborn Resuscitation; Positive Pressure Ventilation; RFM; Respiratory Function Monitor.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ResusRight is currently a not-for-profit research organisation of which Dr Hinder and Dr Tracy are Consultants.

Figures

Fig. 1
Fig. 1
Experimental set up diagram. Note: P − Pressure, F – Flow and V – Volume measured at positions 1 and 2 by respiratory function monitors (RFMs).
Fig. 2
Fig. 2
Mean deflation tidal volume and leak measured by the RFMs (Florian, NM3, Juno and Neo100) for both resuscitation devices (Self-inflating Bag (SIB) and T-piece resuscitator (TPR)), lung compliances (0.6 mL/cmH2O and 2 mL/cmH2O) and imposed leak levels. Reference lines represent the mean ± 10 % of reference RFM measurements for Vte and mean ± 10 % of imposed leak level for leak.
Fig. 3
Fig. 3
Mean PIP and PEEP measured by the RFMs (Florian, NM3, Juno and Neo100) for both resuscitation devices (Self-inflating Bag (SIB) and T-piece resuscitator (TPR)), lung compliances (0.6 mL/cmH2O and 2 mL/cmH2O) and imposed leak levels. Reference lines represent the mean ± 10 % of reference RFM measurements for each imposed leak level.
See this image and copyright information in PMC

References

    1. Kattwinkel J., Stewart C., Walsh B., Gurka M., Paget-Brown A. Responding to compliance changes in a lung model during manual ventilation: perhaps volume, rather than pressure, should be displayed. Pediatrics. 2009;123(3):e465–e470. doi: 10.1542/peds.2008-2012. - DOI - PubMed
    1. Tracy M.B., Halliday R., Tracy S.K., Hinder M.K. Newborn self-inflating manual resuscitators: precision robotic testing of safety and reliability. Arch Dis Child Fetal Neonatal Ed. 2019;104(4):F403–F408. doi: 10.1136/archdischild-2018-315391. - DOI - PMC - PubMed
    1. Schmolzer G.M., Dawson J.A., Kamlin C.O., O'Donnell C.P., Morley C.J., Davis P.G. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2011;96(4):F254–F257. doi: 10.1136/adc.2010.191171. - DOI - PubMed
    1. Murthy V., Dattani N., Peacock J.L., et al. The first five inflations during resuscitation of prematurely born infants. Arch Dis Child Fetal Neonatal Ed. 2012;97(4):F249–F253. doi: 10.1136/archdischild-2011-300117. - DOI - PubMed
    1. Barton S.K., Tolcos M., Miller S.L., et al. Unraveling the links between the initiation of ventilation and brain injury in preterm infants. Front Pediatr. 2015;3:97. doi: 10.3389/fped.2015.00097. - DOI - PMC - PubMed

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