T-piece resuscitators: how do they compare?

Area of Science:

• Neonatal resuscitation
• Medical device engineering
• Pediatric respiratory care

Background:

• T-piece resuscitators (TPR) are increasingly used for newborn resuscitation.
• Traditional TPRs use high resistance valves for positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP).
• A new rPAP device utilizes a dual flow ratio valve for PEEP/CPAP generation.

Purpose of the Study:

• To compare the ventilation performance of different T-piece resuscitator (TPR) devices.
• To evaluate performance across a range of lung compliances relevant to newborns.
• To identify potential discrepancies between set and delivered ventilation parameters.

Main Methods:

• Bench testing of five different TPR devices (Atom, Neopuff, rPAP, GE Panda, Draeger Resuscitaire).
• Ventilation delivered to a test lung model with incremental compliance (0.5-5 mL/cmH2O).
• Standardized settings: Peak Inflation Pressure (PIP) 20 cmH2O, PEEP 5 cmH2O, rate 60/min.

Main Results:

• Four of five devices showed inadvertent PEEP elevations (5.5-10.3 cmH2O) as lung compliance increased.
• One device (rPAP) maintained set PEEP.
• Two devices (GE, Draeger) exceeded set PIP at low compliance (0.5 mL/cmH2O).
• Significant differences in tidal volumes were observed across devices, especially at higher compliances.

Conclusions:

• T-piece resuscitator (TPR) design significantly impacts delivered ventilation.
• Inadvertent PEEP and overdelivery of PIP can occur, varying with lung compliance.
• These variations may pose clinical risks to newborns during resuscitation, particularly those with different lung compliances.