Abstract
BackgroundA T-piece resuscitator (TPR) uses a built-in manometer to set the inflation pressures, but we are not informed what pressures are actually delivered distally. Aim of this study was to measure the proximal and distal pressures under different gas conditions when using a TPR.Methodology/FindingsA test lung was ventilated using a TPR (PIP 25 cmH2O, PEEP 5 cmH2O) with a gas flow rate of 8 L/min. A) Pressure delivered by six different TPRs was tested. To test variability 20 participants were asked to set PEEP and PIP pressures to 25/5 cmH2O. B) PIP and PEEP were measured proximal and distal of the TPR when using standard tubing or heated tubing with or without a humidifier. In experiment A mean (SD) proximal PIP and PEEP of the TPRs were respectively 20.3 (0.3) cmH2O (19.9–20.6 cmH2O) and 4.9 (0.1) cmH2O. When 20 participants set pressures; PIP 26.7 (0.5) cm H2O and PEEP 5.9 (0.44) cmH2O were measured. Experiment B showed that the decrease of PIP between proximal and distal pressures was not clinically significant. However there was a significant decrease of PEEP using the standard tubing (5.1 (0.1) cmH2O proximally versus 4.8 (0.2) cmH2O distally; p<0.001) compared to, when using a humidifier with associated tubing and the humidifier turned on, 5.1 (0.1) proximally versus 3.9 (0.2) cmH2O distally; (p<0.001).Conclusion/SignificanceThe accuracy of the built-in manometer of a TPR is acceptable. Most pressures set proximally are comparable to the actual pressures delivered distally. However, when using tubing associated with the humidifier PEEP decreases distally by 1.1–1.2 cmH2O and users should anticipate on this.
Highlights
For effective neonatal resuscitation at birth appropriate mask technique is necessary for adequate pressure delivery
peak inspiratory pressures (PIP) is a poor proxy for the tidal volume provided during positive pressure ventilation (PPV) [2] it is important for creating a functional residual capacity (FRC) at birth
When using a Neopuff T-piece resuscitator (TPR) device to deliver the set positive end-expiration pressures (PEEP) and PIP, flexible tubing is attached between the device and face mask or endotracheal tube
Summary
For effective neonatal resuscitation at birth appropriate mask technique is necessary for adequate pressure delivery. There is increasing evidence that PEEP is important for lung liquid clearance and maintaining FRC [3] These pressures are often administered using a T-piece resuscitator (TPR) device [4,5]. In our delivery rooms we have recently introduced heated humidified gases for ventilation of newly born preterm infants using a humidifier and longer ventilation tubing with a heater wire In addition, heating and humidifying air changes the gas condition and will influence the dynamic pressures [6]. This could potentially increase the resistance even more.
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