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Protocol for Relative Hydrodynamic Assessment of Tri-leaflet Polymer Valves

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Published on: October 17, 2013

The Neopuff's PEEP valve is flow sensitive.

Colin Patrick Hawkes¹, Eugene Michael Dempsey, C Anthony Ryan

¹Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland.

Acta Paediatrica (Oslo, Norway : 1992)

|November 13, 2010

Summary

The Neopuff's positive end-expiratory pressure (PEEP) valve is more sensitive at lower gas flow rates. Adjusting the PEEP dial by half a rotation at 5 L/min can more than double the PEEP, impacting ventilation settings.

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Area of Science:

Neonatal respiratory support
Mechanical ventilation
Pediatric critical care

Background:

The Neopuff is a device used for neonatal resuscitation.
Current guidelines recommend a gas flow of 5-15 L/min for Neopuff setup.
The sensitivity of the positive end-expiratory pressure (PEEP) valve may vary with gas flow rates.

Purpose of the Study:

To investigate the sensitivity of the Neopuff's PEEP valve across different gas flow rates.
To determine if PEEP valve performance changes within the recommended 5-15 L/min flow range.

Main Methods:

Five Neopuff devices were calibrated to deliver a baseline PEEP of 5 cm H2O.
The number of clockwise rotations to fully occlude the PEEP valve was recorded.
Pressure changes were measured at quarter-rotation increments across flow rates of 5, 10, and 15 L/min.

Main Results:

At 5 L/min, 0.5 rotations occluded the valve, increasing pressure to 11.4 cm H2O.
At 10 L/min, 1.7 rotations were needed, reaching 18.4 cm H2O.
At 15 L/min, 3.4 rotations were required, resulting in 21.5 cm H2O.
Half a rotation at 5 L/min doubled PEEP (5 to 11.4 cm H2O), while at 10 L/min it increased PEEP to 7.7 cm H2O, and at 15 L/min to 6.8 cm H2O.

Conclusions:

The Neopuff's PEEP valve exhibits increased sensitivity at lower gas flow rates.
Clinicians should be aware that small adjustments to the PEEP dial at lower flows (e.g., 5 L/min) can lead to significant PEEP changes.
This heightened sensitivity at 5 L/min necessitates careful titration of PEEP during Neopuff use to avoid barotrauma.