A comparison of three neonatal resuscitation devices

Abstract

Background: Ventilation during neonatal resuscitation involves the use of self-inflating bags, flow-inflating bags, and T-piece resuscitators. The ability of operators to deliver desired peak inspiratory pressures (PIP), positive end expiratory pressures (PEEP), prolonged inflations and the length of time to transition between different pressures has not been compared for all three of these devices. Objective: To compare the ability of neonatal resuscitation personnel to deliver predetermined ventilation interventions using these devices in advance of a clinical trial of neonatal resuscitation. Design/methods: We studied 31 operators (neomatologists, neonatal respiratory therapists, neonatal fellows, a pediatrician, pediatric residents, neonatal nurse practitioners, and neonatal nurses) using a T-piece resuscitator (Neopuff ®, Fisher & Paykel Healthcare, Auckland, New Zealand), a self-inflating bag (Baby Blue II, Vital Signs, Totowa, NJ), and a flow-inflating bag (Model E191 Anesthesia Associates, San Marcos, CA). The self-inflating bag was tested with and without the manufacturer's PEEP valve. Using a continuous pressure recording system and a neonatal manikin, we evaluated the ability to deliver a consistent PIP of 20 or 40 cmH 2O and a PEEP of 5 cmH 2O during 30 s of ventilation, the ability to maintain a 5 s inflation at a PIP of 20 cmH 2O and the time to transition from a PIP of 20 to 40 cmH 2O. Each device was evaluated with and without a qualitative CO 2 detector (Pedicap ® Nellcor Pleasanton, CA). Results: The T-piece resuscitator delivered the desired PIP more precisely and consistently compared with the self-inflating bag at a target of 20 cmH 2O (maximum PIP 20.7 cmH 2O, S.D. = 0.8 versus 24.7 cmH 2O, S.D. = 2.8; p < 0.001). At a target of 40 cmH 2O, the maximum pressure delivered with the T-piece resuscitator was significantly less than both the flow-inflating bag and the self-inflating bag (39.7 cmH 2O, S.D. = 2.1 versus 44 cmH 2O, S.D. = 3.3 versus 45.3 cmH 2O, S.D. = 4.7; p < 0.001). It took significantly longer to increase the PIP from 20 to 40 cmH 2O using the T-piece resuscitator compared to the self-inflating bag or the flow-inflating bag (5.7 s versus 2.2 s versus 1.8 s; p < 0.001), and three operators could not make the transition in the allotted 15 s time limit. During the 5 s prolonged inflation, the T-piece resuscitator and the flow-inflating bag maintained a pressure greater than 18 cmH 2O for a longer time than the self-inflating bag (4 s versus 3.7 s versus 2.2 s; p < 0.001). The self-inflating bag with the PEEP valve in place provided significantly less PEEP than both the T-piece resuscitator and the flow-inflating bag (3.6 cmH 2O versus 4.4 cmH 2O versus 4.4 cmH 2O; p < 0.005). The Pedicap ® did not significantly affect any of the observed results, and there were no consistent operator differences between different disciplines or years of experience. Conclusions: The T-piece resuscitator delivered the desired pressures more accurately, but required greater time to increase the PIP from 20 to 40 cmH 2O. It was difficult to maintain a prolonged inflation and deliver the desired PEEP with the self-inflating bag even with the PEEP valve in place. There is a need for improvement in the design and function of current manual resuscitation devices and for prospective trials to evaluate the optimal method of bag and mask ventilation during resuscitation of the newborn infant.