T-piece resuscitators: how do they compare?

Hinder, Murray; McEwan, Alistair; Drevhammer, Thomas; Donaldson, Snorri; Tracy, Mark

doi:10.1136/archdischild-2018-314860

Cited by 25 publications

(11 citation statements)

References 37 publications

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“…This increase in PEEP under dynamic conditions is probably caused by inadvertent PEEP during PPV at a rate of 60/min. A recent study has shown that TPRs use a screw occlusion flow resistor that imposes substantial expiratory resistance, which is system inflow dependent 16. The finding that PEEP tended to increase more at higher PIP levels during PPV seems to support this assumption.…”

Section: Discussionmentioning

confidence: 82%

Validation of the disposable T-piece resuscitator (Neo-Tee): a bench study

Groene¹,

Jaegere

Nijland

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveThe Neo-Tee Infant T-piece resuscitator is a disposable T-piece resuscitator. The aim of this bench study was to assess the accuracy of the Neo-Tee using a measurement set-up and settings mimicking clinical practice.Study designNine Neo-Tee devices were tested using a face mask interface and a manikin. Pressures were set using the built-in manometer and simultaneously measured at the interface. Peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) were studied under static conditions and positive pressure ventilation (PPV), using a wide range of clinically relevant flows and pressures. Pressures were measured without adjusting for a possible offset of PIP and PEEP after switching from static pressures to PPV. In an additional subset of measurements, PIP/PEEP offsets on the Neo-Tee manometer after starting PPV were adjusted.ResultsUnder static conditions, setting the PEEP level with the Neo-Tee manometer results in overestimation of the true PEEP applied at the airway opening, with a difference of approximately 1.5 cmH2O. When switching to PPV, this difference almost disappears. In contrast to PEEP, PIP levels measured at the airway opening were accurate.Adjusting PIP and PEEP on the built-in manometer after starting PPV was necessary in all measurements, but this did not improve the accuracy of the targeted pressure delivery, especially for PEEP. A gas flow rate of 5 L/min was insufficient to reach commonly used PEEP levels of 5 cmH2O.ConclusionThe Neo-Tee T-piece resuscitator is accurate for delivering a static inflation and PPV, but not for delivering continuous positive airway pressure.

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Section: Discussionmentioning

confidence: 82%

Validation of the disposable T-piece resuscitator (Neo-Tee): a bench study

Groene¹,

Jaegere

Nijland

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…Studies could also explore the alternative hypotheses that the reduced peak flow seen with a prolonged inspiratory rise time and the increased expiratory time constants are beneficial. Possible systems for comparisons are low resistance resuscitation systems or ventilators with adequate expiratory valves ( 4 , 17 ). The expiratory time constants of these systems are not known and need to be determined.…”

Section: Discussionmentioning

confidence: 99%

“…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. In previous studies on TPR systems, a risk of inadvertent PEEP, also referred to as auto-PEEP, was identified ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Neonatal Resuscitation With T-Piece Systems: Risk of Inadvertent PEEP Related to Mechanical Properties

et al. 2021

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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.

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“…In this context, the study of Hinder et al ,13 ‘T-piece resuscitators: how do they compare’, brings new and impacting information on the performance of pressure ventilators commercially available around the world. This controlled test bench study compared the ventilation performance among four T-piece resuscitators currently in use in most delivery rooms with an airway pressure limit valve with a mechanical screw occlusion system and a recently released T-piece resuscitator that uses a dual flow ratio valve to provide PEEP during ventilation or continuous positive airway pressure.…”

mentioning

confidence: 99%

“…Finding the best approaches to help neonates in their first minutes after birth is challenging. The study of Hinder et al 13 gives us a warning that it is inappropriate to generalise findings from older children and adults to neonates, and that results of studies done in very and extremely preterm infants may not apply to more mature infants. Positive pressure ventilation devices, used to save lives around the world in the most important procedure of neonatal resuscitation during the golden minute, should be better studied and audited before being extensively used in clinical practice.…”

mentioning

confidence: 99%