Abstract
Background: Resuscitation of infants using T-piece resuscitators (TPR) allow positive pressure ventilation with positive end-expiratory pressure (PEEP). The adjustable PEEP valve adds resistance to expiration and could contribute to inadvertent PEEP. The study indirectly investigated risk of inadvertent peep by determining expiratory time constants. The aim was to measure system expiratory time constants for a TPR device in a passive mechanical model with infant lung properties.Methods: We used adiabatic bottles to generate four levels of compliance (0.5–3.4 mL/cm H2O). Expiratory time constants were recorded for combinations of fresh gas flow (8, 10, 15 L/min), PEEP (5, 8, 10 cm H2O), airway resistance (50, 200 cm H2O/L/sec and none), endotracheal tube (none, size 2.5, 3.0, 3.5) with a peak inflation pressure of 15 cm H2O above PEEP.Results: Low compliances resulted in time constants below 0.17 s contrasting to higher compliances where the expiratory time constants were 0.25–0.81 s. Time constants increased with increased resistance, lower fresh gas flows, higher set PEEP levels and with an added airway resistance or endotracheal tube.Conclusions: The risk of inadvertent PEEP increases with a shorter time for expiration in combination with a higher compliance or resistance. The TPR resistance can be reduced by increasing the fresh gas flow or reducing PEEP. The expiratory time constants indicate that this may be clinically important. The risk of inadvertent PEEP would be highest in intubated term infants with highly compliant lungs. These results are useful for interpreting clinical events and recordings.
Highlights
T-piece resuscitators (TPR) are used for resuscitation of newborn infants worldwide and recommended in international guidelines [1]
The positive end expiratory pressure (PEEP) and continuous positive airway pressure treatment (CPAP) of TPR systems are generated by a fresh gas flow leaving the breathing circuit through an adjustable expiratory resistance valve
With a compliance of 1.1 mL/cm H2O the time constants were above 0.17 s when high resistances were used (2.5 ET-tube, Rp200 airway resistance and high PEEP with a low fresh gas flow)
Summary
T-piece resuscitators (TPR) are used for resuscitation of newborn infants worldwide and recommended in international guidelines [1]. These devices allow positive pressure ventilation (PPV) with positive end expiratory pressure (PEEP) of infants with inadequate respiratory effort and continuous positive airway pressure treatment (CPAP) of breathing infants. The PEEP and CPAP of TPR systems are generated by a fresh gas flow leaving the breathing circuit through an adjustable expiratory resistance valve. The adjustable resistor valve generates PEEP by interposing expiratory resistance with the un-intended effect of prolonging the time required for the lungs to deflate. The aim was to measure system expiratory time constants for a TPR device in a passive mechanical model with infant lung properties
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