Changing gas flow during neonatal resuscitation: a manikin study

Area of Science:

• Neonatal Resuscitation
• Respiratory Physiology
• Medical Device Technology

Background:

• T-piece devices are common in neonatal resuscitation.
• Resuscitators may incorrectly adjust gas flow to manage airway pressures.
• This can lead to suboptimal ventilation and potential harm.

Purpose of the Study:

• To quantify the impact of varying gas flow on key ventilation parameters during T-piece positive pressure ventilation (PPV).
• To assess effects on peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), expiratory tidal volume (V(Te)), and mask leak.
• To provide evidence-based guidance on gas flow adjustments during neonatal resuscitation.

Main Methods:

• A modified, leak-free manikin was used with a Neopuff T-piece device.
• Twenty neonatal staff members performed PPV under controlled conditions.
• Two study arms investigated the effects of increasing gas flow (5-15 L/min) with fixed or adjusted pressure settings.

Main Results:

• Increasing gas flow significantly elevated PEEP and mask leak while decreasing V(Te) when pressure settings were maintained.
• PIP showed a slight increase at higher flow rates.
• When PIP and PEEP were actively maintained, V(Te) and mask leak remained stable despite flow changes.

Conclusions:

• Elevating gas flow during T-piece PPV can detrimentally increase PEEP and mask leak, compromising ventilation.
• Gas flow adjustments should be infrequent during T-piece resuscitation.
• Optimal mask seal and appropriate pressure settings are crucial for effective neonatal resuscitation.