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T-piece resuscitators: how do they compare?
  1. Murray Hinder1,2,
  2. Alistair McEwan2,
  3. Thomas Drevhammer3,
  4. Snorri Donaldson3,
  5. Mark Brian Tracy1,4
  1. 1 Neonatal Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2 Faculty of Engineering and Information Technologies, BMET Institute, Sydney University, Sydney, New South Wales, Australia
  3. 3 Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  4. 4 Department of Paediatrics and Child Health, Sydney University, Westmead, New South Wales, Australia
  1. Correspondence to Murray Hinder, Neonatal Intensive Care Unit, Westmead Hospital, Westmead, NSW 2145, Australia; murray.hinder{at}


Background The T-piece resuscitator (TPR) has seen increased use as a primary resuscitation device with newborns. Traditional TPR design uses a high resistance expiratory valve to produce positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) at resuscitation. A new TPR device that uses a dual flow ratio valve (fluidic flip) to produce PEEP/CPAP is now available (rPAP). We aimed to compare the measured ventilation performance of different TPR devices in a controlled bench test study.

Design/methods Single operator provided positive pressure ventilation to an incremental testlung compliance (Crs) model (0.5–5 mL/cmH2O) with five different brands of TPR device (Atom, Neopuff, rPAP, GE Panda warmer and Draeger Resuscitaire). At recommended peak inflation pressure (PIP) 20 cmH2O, PEEP of 5 cmH2O and rate of 60 inflations per minute.

Results 1864 inflations were analysed. Four of the five devices tested demonstrated inadvertent elevations in mean PEEP (5.5–10.3 cmH2O, p<0.001) from set value as Crs was increased, while one device (rPAP) remained at the set value. Measured PIP exceeded the set value in two infant warmer devices (GE and Draeger) with inbuilt TPR at Crs of 0.5 (24.5 and 23.5 cmH2O, p<0.001). Significant differences were seen in tidal volumes across devices particularly at higher Crs (p<0.001).

Conclusions Results show important variation in delivered ventilation from set values due to inherent TPR device design characteristics with a range of lung compliances expected at birth. Device-generated inadvertent PEEP and overdelivery of PIP may be clinically deleterious for term and preterm newborns or infants with larger Crs during resuscitation.

  • newborn
  • resuscitation
  • inadvertent PEEP
  • T-piece resuscitator

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  • Contributors MKH: study design, data collection, data and statistical analysis and writing of manuscript. MBT: data collection, data and statistical analysis and writing of manuscript. AM and SD: data interpretation, manuscript writing, construction and review. TD: manuscript writing, construction and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TD is one of the inventors of the rPAP system and was not involved in collection of data or its analysis.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Sydney West Area Health Service Research and Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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