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T-piece resuscitators: can they provide safe ventilation in a low compliant newborn lung?
  1. Murray Kenneth Hinder1,2,
  2. Thomas Drevhammar3,
  3. Snorri Donaldsson3,
  4. Matthew Boustred4,
  5. Matthew Crott4,
  6. Mark Brian Tracy1,2
  1. 1Neonatal Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2Department of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
  4. 4School of Biomedical Engineering, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Murray Kenneth Hinder, Neonatal Intensive Care Unit, Westmead Hospital, Westmead NSW 2145, New South Wales, Australia; murray.hinder{at}health.nsw.gov.au

Abstract

Background T-piece resuscitators (TPRs) are used for primary newborn resuscitation in birthing and emergency rooms worldwide. A recent study has shown spikes in peak inflation pressure (PIP) over set values with two brands of TPRs inbuilt into infant warmer/resuscitation platforms. We aimed to compare delivered ventilation between two TPR drivers with inflation pressure spikes to a standard handheld TPR in a low test lung compliance (Crs), leak-free bench test model.

Methods A single operator provided positive pressure ventilation to a low compliance test lung model (Crs 0.2–1 mL/cmH2O) at set PIP of 15, 25, 35 and 40 cmH2O. Two TPR devices with known spikes (Draeger Resuscitaire, GE Panda) were compared with handheld Neopuff (NP). Recommended settings for positive end-expiratory pressure (5 cmH2O), inflation rate of 60/min and gas flow rate 10 L/min were used.

Results 2293 inflations were analysed. Draeger and GE TPR drivers delivered higher mean PIP (Panda 18.9–49.5 cmH2O; Draeger 21.2–49.2 cmH2O and NP 14.8–39.9 cmH2O) compared with set PIP and tidal volumes (TVs) compared with the NP (Panda 2.9–7.8 mL; Draeger 3.8–8.1 mL; compared with NP 2.2–6.0 mL), outside the prespecified acceptable range (±10% of set PIP and ±10% TV compared with NP).

Conclusion The observed spike in PIP over set values with Draeger and GE Panda systems resulted in significantly higher delivered volumes compared with the NP with identical settings. Manufacturers need to address these differences. The effect on patient outcomes is unknown.

  • resuscitation
  • neonatology
  • intensive care
  • respiratory
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Footnotes

  • Contributors MKH: study design, data collection, data and statistical analysis, and writing of the manuscript. MBT: data collection, data and statistical analysis, and writing of the manuscript. TD and SD: data interpretation, manuscript writing, construction and review. MB and MC: 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 None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Sydney West Area Health Service Research and Ethics Committee # 2001–01 QA.

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

  • Data availability statement Data are available upon reasonable request. Data available as spreadsheet from author if requested (https://orcid.org/0000-0002-9179-316X).

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