Leak during term neonatal CPAP stabilisation: does resuscitation device design affect delivered PEEP - a bench study

Area of Science:

• Neonatal respiratory support
• Mechanical ventilation
• Cardiopulmonary resuscitation

Background:

• Mask leak is a frequent challenge during neonatal resuscitation, potentially compromising ventilation efficacy.
• The impact of mask leak on continuous positive airway pressure (CPAP) delivery during assisted spontaneous breathing in neonates is not well-understood.

Purpose of the Study:

• To compare the performance of two T-piece resuscitation devices, the high-resistance Neopuff and the low-resistance rPAP, in the presence of mask leak during CPAP delivery.
• To evaluate how differing device resistances affect CPAP delivery under various leak conditions.

Main Methods:

• A term dynamic lung model was utilized to simulate neonatal respiratory mechanics.
• Two T-piece devices (Neopuff and rPAP) were tested at varying set positive end-expiratory pressure (PEEP) levels (5, 7, and 9 cmH2O) with simulated continuous leaks.
• Key parameters including mean airway pressure, pressure fluctuations, tidal volume (VT), and leak flow were measured.

Main Results:

• Mask leak significantly reduced delivered PEEP, with greater reductions observed at higher PEEP settings and leak levels.
• The rPAP device maintained delivered PEEP closer to the set value compared to the Neopuff device across all leak conditions.
• Tidal volume delivery was reduced with the Neopuff device, particularly at lower leak levels, and was influenced by the delivered PEEP.

Conclusions:

• The performance of T-piece resuscitation devices in the presence of mask leak varies significantly.
• The rPAP device demonstrated superior ability to maintain target PEEP levels during leaks compared to the Neopuff.
• Device resistance influences the impact of leaks on delivered tidal volume and overall ventilatory support in neonates.