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Free-flow oxygen delivery using a T-piece resuscitator
  1. Jennifer A Dawson1,
  2. Peter G Davis2,
  3. C Omar F Kamlin3,
  4. Colin J Morley3
  1. 1Neonatal Services, Royal Women’s Hospital
    Carlton, Victoria, Australia
  2. 2Department of Obstetrics and Gynaecology, University of Melbourne
    Melbourne, Victoria, Australia
  3. 3Neonatal Services, Royal Women’s Hospital
    Carlton, Victoria, Australia
  1. Jennifer Dawson, Neonatal Nurse Researcher, Division of Newborn Services, Royal Women’s Hospital, Carlton, Victoria 3053, Australia; jennifer.dawson{at}

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T-pieces are increasingly used for administering intermittent positive pressure ventilation (IPPV) during neonatal resuscitation.1 They can also be used to provide free-flowing oxygen to babies who are breathing but remain cyanosed.2 The Neonatal Resuscitation Program (NRP) guidelines recommend that when using a T-piece resuscitator the mask should be loosely placed on the infant’s face with the positive end expiratory pressure (PEEP) valve occluded to allow delivery of a reliable amount of oxygen.2 There are no reports documenting the percentage of oxygen delivered when the PEEP valve is, or is not, occluded. The aim of this study was to determine the oxygen concentration delivered from a T-piece resuscitator and mask when the PEEP valve is occluded and when it is left open.


We simulated delivering free-flowing oxygen with a Neopuff Infant Resuscitator (Fisher and Paykel, New Zealand) fitted with a size 0/1 mask (Laerdal, Stavanger, Norway) held 1 cm above the face of a Laerdal neonatal manikin (Laerdal, Stavanger, Norway), using 100% oxygen flowing into the Neopuff. Oxygen concentrations were measured with an oxygen analyser (Hudson RCI, Durham, North Carolina, USA) fitted inside the manikin’s mouth, with the sensor level with the lips. The analyser was calibrated with air and 100% oxygen before each study. Five Neopuffs were tested. The oxygen concentration at 30 s was recorded with oxygen flow rates ranging from 5 l/min to 8 l/min.


Table 1 shows the mean (SD) percentage of oxygen delivered to the face at different flow rates. At 5–8 l/min with the mask 1 cm above the face, on average 97% oxygen was delivered when the PEEP valve was occluded and 95% when the valve was not occluded. The difference between the percentage of oxygen delivered when the valve was occluded or open was statistically significant (see table 1 for p values) but probably not clinically important.

Table 1 Mean (SD) oxygen concentration, measured at a manikin’s mouth after 30 s, when 100% oxygen was delivered using a Neopuff Infant Resuscitator with 100% oxygen flowing into the inlet at different flow rates, when the positive end expiratory pressure (PEEP) valve was occluded and when it was open


This is the first published report on the amount of oxygen delivered by a T-piece resuscitator with the PEEP valve occluded or open. The device delivers close to 100% oxygen in both situations. We have previously shown that high concentrations of free-flow oxygen can be provided either by a self-inflating bag, or with oxygen tubing in a cupped hand, held close to the infant’s face.3 The percentage of oxygen delivered by the Neopuff is similar to that delivered by these two methods. The benefits of using the Neopuff Infant Resuscitator rather than the other free-flow oxygen delivery methods include the ability to provide continuous positive airway pressure to spontaneously breathing infants as well as providing IPPV with PEEP, without having to change equipment during resuscitation.


The Neopuff is able to deliver close to 100% free-flow oxygen with the PEEP valve occluded or open.


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  • Supported in part by an RWH postgraduate degree scholarship (COFK, JAD) and an NHMRC Practitioner Fellowship (PGD).

  • Competing interests: None.

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