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

## TL;DR

This study compares new and old respiratory function monitors for newborn resuscitation, finding they perform similarly but are affected by high leaks.

## Contribution

The study introduces a bench comparison of new-generation and legacy respiratory function monitors under leak conditions.

## Key findings

- New-generation RFMs showed comparable accuracy to legacy devices at zero leak.
- High leaks significantly reduced accuracy of SIB-delivered volumes but less so for TPR.
- All RFMs accurately measured leak levels up to 90%.

## Abstract

•Respiratory function monitors have been shown to improve resuscitation technique.•Legacy respiratory function monitors are complex and lack portability.•New-generation respiratory function monitors feature a simpler and portable design.•Accuracy of new-generation respiratory function monitors compares to legacy devices.•Leak impacts the accuracy and performance of RFMs, but only at high leak levels.

Respiratory function monitors have been shown to improve resuscitation technique.

Legacy respiratory function monitors are complex and lack portability.

New-generation respiratory function monitors feature a simpler and portable design.

Accuracy of new-generation respiratory function monitors compares to legacy devices.

Leak impacts the accuracy and performance of RFMs, but only at high leak levels.

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.

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.

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.

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.