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Letter
Potential hazards of the Neopuff: using appropriate gas flow
  1. C J Morley1,2,3,
  2. G M Schmölzer1,2,3,
  3. P G Davis1,2,3
  1. 1
    Neonatal Services, The Royal Women’s Hospital, Melbourne, Australia
  2. 2
    Murdoch Children Research Institute, Melbourne, Australia
  3. 3
    Department of Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Australia
  1. Correspondence to Professor C Morley, 23 High Street, Great Shelford, Cambridge CB22 5EH, UK; colin{at}morleys.net

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Regarding Potential hazard of the Neopuff (see page 461),1 Dr Hawkes is right: if a gas flow meter is used with the Neopuff that will deliver very high flows when turned up to its maximum flow, which may be over 80 l/min, when the flow is increased above the set level dangerously high levels of PIP and PEEP will be delivered.

What is not commonly known is that some flow meters used in neonatal care that are marked to deliver a flow from 0 to 15 l/min can deliver flows up to 80 l/min, which will overwhelm the pressure control valves in the Neopuff. A flow meter that can deliver a maximum gas flow above 15 l/min should never be used with the Neopuff.

The practical message for all who use the Neopuff is that it should be used according to the manufacturer’s instructions.

  1. The recommended operating gas flow range is 5 to 15 l/min. It specifically says, “Do not attempt to use a flow higher than 15 l/min.”

  2. Adjust the gas supply to the desired flow rate between 5 and 15 l/min then set the PIP and PEEP.

  3. The Neopuff should only be used on a baby after checking that correct pressures will be delivered to the baby.

If the Neopuff PIP and PEEP are set with a flow of 5 l/min, then if the flow is increased to 10 l/min, the PEEP will rise to about 15 cm H2O, and the PIP will be similar to, or just above, the set PIP even when max PIP is set very high. If the flow is increased to 15 l/min, the PEEP rises to about 24 cm H2O, and PIP is similar to, or just above, the set PIP even when max PIP is set very high. The effect of increasing the flow to 15 l/min will be much less if the PIP and PEEP were set at a flow of 10 l/min at the start.

The practical clinical messages are simple:

  1. Choose a flow rate you are going to use; we suggest 8 l/min should be more than adequate; set the PEEP and PIP, and then do not alter the flow.

  2. If the PEEP and PIP are not being delivered during the resuscitation, this is due to a large leak between the mask and face, and that should be remedied by altering mask position and hold, and not by increasing the flow.

REFERENCE

Footnotes

  • Funding The research is supported by Australian National Health and Medical Research Council Program Grant No 384100. GMS is supported in part by a Royal Women’s Hospital Postgraduate Research Degree Scholarship, a Monash Graduate Scholarship and Monash International Postgraduate Research Scholarship. PGD is supported in part by an Australian National Health and Medical Research Council Practitioner Fellowship.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed

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