Reliability of two common PEEP-generating devices used in neonatal resuscitation

Approximately 15% of neonates require respiratory support at birth, the demand of which increases with decreasing gestational age. Positive end-expiratory pressure (PEEP) stabilizes the airways and improves both pulmonary functional residual capacity and compliance. Self-inflating bags, which can be used with and without a PEEP-valve, are most commonly used for neonatal resuscitation, pressure limited T-piece resuscitators are becoming increasingly popular. The aim of the study was to investigate the reliability of PEEP provision of both systems.

An intubated, leak free mannequin (equivalent to 1 kg neonate, pulmonary compliance 0.2 ml*cmH (2)O (-1)) was used for testing both devices. Eleven PEEP-valves attached to a 240 ml self-inflating bag and 5 T-piece resuscitators were investigated. Provision of a PEEP of 5 cmH (2)O (gas flow of 8l/min) at manual ventilation at breaths 40/min was investigated. Data were recorded using a standard pneumotachograph.

Only 1/11 PEEP-valves provided a PEEP of 5 cmH (2)O (mean (SD) 2.95 (1.82) cmH (2)O, CV 0.62%), in 5/11 (45%) PEEP was <3 cmH (2)O, in 2 of the PEEP-valves produced a PEEP below 0.3 cmH (2)O. All T-piece resuscitators provided a PEEP >5 cmH (2)O (mean 5.59 (0.32) cmH (2)O, CV 0.06%). Significant differences in individual performance per device (p<0.05) and between systems (p=0.007) were found.

Self-inflating bags did not reliably provide the desired PEEP of 5 cmH (2)O, whereas T-piece resuscitators did reliably provide the set PEEP-level, with less variability. When using self-inflating bags with PEEP-valves, neonatologists should check the equipment regarding the reliability of PEEP provision.