Proximal airway pressure monitoring in the neonatal ICU

The static and dynamic responses of diaphragm-type pressure manometers currently used with manual ventilation in the neonatal ICU were determined at different pressures and frequencies. Using a precalibrated transducer attached to a closed-loop system, the manometer peak pressure was adjusted to 15, 20, 25, and 30 cm H2O, first for static measurements and then again while the frequency was increased from 20 to 200 breath/min in increments of 20. Most manometers with inlet flow-restricting devices built into the manometer or attached to the connection system in a ventilator significantly underestimated the delivered pressure as the peak inflation pressure and frequency were increased. In those manometers without inlet flow restrictors the correlation between transducer pressure and observed manometer pressure was close. Diaphragm-type pressure manometers with inlet flow-restricting devices may substantially underestimate the delivered proximal airway pressure when incorporated into neonatal manual ventilation equipment.