131 - Respiratory function monitoring to guide placement and increase the safety of a supraglottic airway device in neonates

Poster Number: 131
Publication Number: 131.3008

Background: The supraglottic airway device (SAD) is a minimally invasive method for airway management, which can be more effective than mask ventilation and shows less complications than endotracheal intubation. However, the SAD is still an underrecognized tool in neonatology.

Objective: This study investigated the applicability of a SAD in neonates for intensive care interventions. We introduced the combined use of a SAD and a respiratory function monitor (RFM) and validated the accuracy of the RFM to show correct placement using videos from bronchoscopy.

Design/Methods: This single-center case-control study was carried out at a tertiary NICU at the Medical University of Vienna.

Patients received a SAD for neurosurgical or endoscopic interventions. There were no exclusion criteria. Patients were either ventilated with a SAD and a hidden RFM or a SAD and a visible RFM. Feedback from the visible RFM was used to assess SAD placement and optimize ventilation quality.

The primary outcome was the percentage of ventilations within a tidal volume range of 4-8ml/kg (pVTe). Secondary outcomes included other ventilatory data, the number of attempts and duration of SAD insertion.

Results: A total of six patients were included in this study. Of these, two patients were ventilated with a hidden RFM and four patients with a visible RFM. We identified that with the combined use of a SAD and a visible RFM, pVTe was increased (median: 14.7% vs. 69.7%), mask leak was decreased (median: 74.8% vs. 17.6%), and fewer attempts were needed for successful placement (median: 3 attempts vs. 1 attempt). We could substantiate that the RFM is a reliable tool for evaluation of SAD placement through endoscopy, showing that low values for leakage coincide with anatomically correct placement.

Conclusion(s): This study demonstrates that the RFM is a reliable tool to assess SAD placement. Our findings contribute to a safer use of the SAD as an airway management tool in a high-risk patient collective.