Do we deliver the pressures we intend to when using a T-piece resuscitator?

Area of Science:

• Neonatal care
• Respiratory physiology

Background:

• T-piece resuscitators (TPR) have built-in manometers to set inflation pressures.
• Actual delivered pressures at the distal end of TPRs are often unknown.
• This study investigates proximal versus distal pressures in TPRs under various conditions.

Purpose of the Study:

• To measure proximal and distal pressures delivered by a T-piece resuscitator (TPR).
• To evaluate pressure accuracy under different gas conditions and tubing setups.
• To assess the clinical significance of pressure discrepancies.

Main Methods:

• Ventilation of a test lung using a TPR with set PIP/PEEP and gas flow.
• Measurement of proximal and distal PIP and PEEP with standard and heated/humidified tubing.
• Testing of six different TPRs and pressure settings by 20 participants.

Main Results:

• Proximal PIP and PEEP measurements were generally close to set values.
• Peak inspiratory pressure (PIP) showed no clinically significant proximal-distal difference.
• Positive end-expiratory pressure (PEEP) significantly decreased with standard (0.3 cmH₂O) and humidified (1.2 cmH₂O) tubing.

Conclusions:

• The T-piece resuscitator (TPR) manometer accuracy is acceptable for clinical use.
• Distal PEEP delivery is reduced when using humidifier-associated tubing.
• Anticipate and adjust for PEEP pressure loss when using humidified ventilation with TPRs.