Tidal volumes and pressures delivered by the NeoPuff T-piece resuscitator during resuscitation of term newborns

Bjorland, Peder Aleksander; Ersdal, Hege; Haynes, Joanna; Ushakova, Anastasia; Øymar, Knut; Rettedal, Siren

doi:10.1016/j.resuscitation.2021.12.006

Cited by 7 publications

(10 citation statements)

References 34 publications

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“…We found marked variability of V t measured in term and late preterm infants when using currently recommended pressure levels for PPV during delivery room stabilization. These findings are in line with recently published data in term infants [ 7 ]. Our data, however, highlight that not only was there substantial variability between infants, but V t was inconsistent within the same individual and leak and obstruction were common.…”

Section: Discussionsupporting

confidence: 93%

“…The recommended PIP for PPV in the delivery room is based on limited evidence [ 1 ] and it remains unclear whether it is sufficient to achieve adequate tidal volumes and lung aeration. Consistent with other reports, our data show that tidal volumes vary considerably despite a fixed PIP [ 7 ]. V t tended to be lower in infants who were subsequently intubated.…”

Section: Discussionsupporting

confidence: 93%

“…In this study median facemask leak was 30% and obstruction occurred in 43% of infants. Leak was similar to that previously reported [ 7 ]. The incidence of obstruction in term infants has not been reported before.…”

Section: Discussionsupporting

confidence: 90%

“…In term and late preterm infants, less is known about the variability of measured V t and changes of V t over time. A recent single center study reported a median tidal volume at the lower end of the recommended range and substantial variation in tidal volumes measured in term infants [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Tidal volumes during delivery room stabilization of (near) term infants

et al. 2022

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Background We sought to assess tidal volumes in (near) term infants during delivery room stabilization. Methods Secondary analysis of a prospective study comparing two facemasks used for positive pressure ventilation (PPV) in newborn infants ≥ 34 weeks gestation. PPV was provided with a T-piece device with a PIP of 30 cmH2O and positive end-expiratory airway pressure of 5 cmH2O. Expired tidal volumes (Vt) were measured with a respiratory function monitor. Target range for Vt was defined to be 4 – 8 ml/kg. Results Twenty-three infants with a median (IQR) gestational age of 38.1 (36.4 – 39.0) weeks received 1828 inflations with a median Vt of 4.6 (3.3 – 6.2) ml/kg. Median Vt was in the target range in 12 infants (52%), lower in 9 (39%) and higher in 2 (9%). Thirty-six (25—27) % of the inflations were in the target rage over the duration of PPV while 42 (25 – 65) % and 10 (3 – 33) % were above and below target range. Conclusions Variability of expiratory tidal volume delivered to term and late preterm infants was wide. Reliance on standard pressures and clinical signs may be insufficient to provide safe and effective ventilation in the delivery room. Trial registration This is a secondary analysis of a prospectively registered randomized controlled trial (ACTRN12616000768493).

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Tidal volumes during delivery room stabilization of (near) term infants

et al. 2022

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“…The unstable HR group shown in Figure 4D were somewhat unexpected, and we will investigate in more detail the potential causes (e.g., vulnerability of the newborn) and specifically the relationship with delivered PPV in a subsequent study. From a recent study including 129 term newborns resuscitated with a t‐piece resuscitator, we described a substantial variation in delivered tidal volumes at the lower end of the recommended range at median 4.5 ml/kg for the initial inflations 21 . Much higher tidal volumes were delivered by bag‐mask ventilation (no PEEP) in a study of 215 newborns in a low‐resource setting, were tidal volumes of 9.3 ml/kg produced the most rapid increase in HR during PPV 22 .…”

Section: Discussionmentioning

confidence: 99%

Newborns requiring resuscitation: Two thirds have heart rate ≥100 beats/minute in the first minute after birth

et al. 2023

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Newborn heart rate (HR) is considered one of the most important markers of need for, and response to, resuscitation after birth. 1 Yet, there is no accurate data on distribution of HR from birth and during the first 60 s after birth in newborns requiring resuscitation. This is the critical time frame when decisions should be made on whether to clamp and cut the cord, transfer the newborn to the resuscitation table and initiate positive pressure ventilation (PPV). According to guidelines, PPV should be initiated within 60 s if the newborn fails to establish spontaneous and effective breathing following drying and stimulation, and/or if HR is <100 beats/minute (bpm), if HR does not increase if initially low, or if HR decreases if initially fast. 2 Chest compressions are indicated if HR is <60 bpm

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Newborn resuscitation timelines: Accurately capturing treatment in the delivery room

Pike,

Kolstad,

Eilevstjønn

et al. 2024

Resuscitation

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Tidal volumes and pressures delivered by the NeoPuff T-piece resuscitator during resuscitation of term newborns

Abstract: Aim: T-piece resuscitators are commonly used for respiratory support during newborn resuscitation. This study aimed to describe delivered pressures and tidal volumes when resuscitating term newborns immediately after birth, using the NeoPu T-piece resuscitator.

Cited by 7 publications

References 34 publications

Tidal volumes during delivery room stabilization of (near) term infants

Tidal volumes during delivery room stabilization of (near) term infants

Newborns requiring resuscitation: Two thirds have heart rate ≥100 beats/minute in the first minute after birth

Newborn resuscitation timelines: Accurately capturing treatment in the delivery room

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