Modified interface between pediatric ventilator and Ayre's T-piece for use in neonates

The lowest tidal volume delivered by most of the pediatric anesthesia ventilators could be large for neonates, and may generate unacceptably high peak airway pressures. The effective tidal volume can however be reduced by connection of a small rubber bag between the ventilator and the expiratory limb of the Ayre's T-piece circuit to divide the delivered gas mixture between the added bag and the neonate's lungs. The delivered tidal volume by the ventilator can then be manipulated to achieve the desired peak inspiratory pressure; 18-20 cm H2O in neonates with normal lung compliance. The modification was found to be simple, safe and convenient.