Delivery of positive end-expiratory pressure to preterm lambs using common resuscitation devices

Thió, Marta; Dawson, Jennifer A; Crossley, Kelly J.; Moss, Timothy; Roehr, Charles C; Polglase, Graeme R.; Davis, Peter G; Hooper, Stuart B.

doi:10.1136/archdischild-2017-314064

Cited by 7 publications

(4 citation statements)

References 34 publications

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“…The TPR is widely used for neonatal resuscitation and resuscitation of infants <10 kg around the world and is recommended as the primary modality to deliver newborn resuscitation. In manikin models, it has been demonstrated that a TPR provides consistent and accurate pressures in neonatal (18). The lung compliance or Rrs of the system was not recorded.…”

Section: Discussionmentioning

confidence: 99%

“…Hinder et al studied TPR on a test lung with varying compliance and reported a significant increase in PEEP with increased compliance ( 17 ). Thio et al examined preterm lambs using a TPR and SIB at set PEEP (5, 7, 10 cmH 2 O) with set PIP of 30 cmH 2 O and varying rates at 20, 40 and 60 ipm with and without gas flow ( 18 ). The lung compliance or R rs of the system was not recorded.…”

Section: Discussionmentioning

confidence: 99%

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Positive end expiratory pressure and respiratory system resistance between self-inflating bag and T-piece resuscitator in a cadaveric piglet lung model

et al. 2022

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IntroductionIn neonatal resuscitation, T-piece resuscitator (TPR) are used widely, but the evidence is limited for their use in infants born at term gestation. The aim of this study was to compare the delivered positive end expiratory pressure (PEEP) and respiratory system resistance (Rrs) using TPR and self-inflating bag (SIB) in a cadaveric piglet model.MethodsCadaveric newborn piglets were tracheotomised, intubated (cuffed tube) and leak tested. Static lung compliance was measured. Positive pressure ventilation was applied by TPR and SIB in a randomized sequence with varying, inflations per minute (40, 60 and 80 min) and peak inspiratory pressures (18 and 30 cmH2O). PEEP was constant at 5 cmH2O. The lungs were washed with saline and static lung compliance was re-measured; ventilation sequences were repeated. Lung inflation data for the respiratory mechanics were measured using a respiratory function monitor and digitally recorded for both pre and post-lung wash inflation sequences. A paired sample t-test was used to compare the mean and standard deviation.ResultsThe mean difference in PEEP (TPR vs. SIB) was statistically significant at higher inflation rates of 60 and 80 bpm. At normal lung compliance, mean difference was 1.231 (p = 0.000) and 2.099 (p = 0.000) with PIP of 18 and 30 cmH2O respectively. Significantly higher Rrs were observed when using a TPR with higher inflation rates of 60 and 80 bpm at varying lung compliance.ConclusionTPR is associated with significantly higher PEEP in a compliant lung model, which is probably related to the resistance of the TPR circuit. The effect of inadvertent PEEP on lung mechanics and hemodynamics need to be examined in humans. Further studies are needed to assess devices used to provide PEEP (TPR, SIB with PEEP valve, Anaesthetic bag with flow valve) during resuscitation of the newborn.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Positive end expiratory pressure and respiratory system resistance between self-inflating bag and T-piece resuscitator in a cadaveric piglet lung model

et al. 2022

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“…Mit einem selbstfüllenden Beatmungsbeutel kann grundsätzlich kein CPAP verabreicht werden und selbst mit einem PEEP-Ventil ist die Verabreichung eines konstanten endexspiratorischen Drucks wahrscheinlich kaum möglich [226][227][228][239][240][241][242]. Die Produkteigenschaften verschiedener T-Stück-Systeme und auch selbstfüllender Beatmungsbeutel variieren erheblich, mit Auswirkungen während ihrer Verwendung [243].…”

Section: Hilfsmittel Zur Assistierten Beatmungunclassified

Versorgung und Reanimation des Neugeborenen nach der Geburt

Madar

Roehr

Ainsworth³

et al. 2021

Notfall Rettungsmed

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Die vorliegenden Leitlinien des European Resuscitation Council zur Versorgung und Reanimation des Neugeborenen nach der Geburt beruhen auf dem International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support (NLS). Sie beinhalten Empfehlungen zur Versorgung und Reanimation des reifen Neugeborenen und zur Stabilisierung des Frühgeborenen. Sie umfassen den aktualisierten Algorithmus zur Reanimation des Neugeborenen, die Vorbereitungen vor der Versorgung eines Neugeborenen, die Themen Training und Ausbildung, Wärmemanagement, Empfehlungen zum Abnabeln, die initiale Beurteilung und Einschätzung des Neugeborenen, das Atemwegsmanagement, inklusive einer Notfallbeatmung, und die Kreislaufunterstützung im Falle einer vollen Reanimation. Darüber hinaus finden sich Empfehlungen zur Kommunikation mit den Eltern und ethische Überlegungen, in welchen Situationen erwogen werden soll, auf Reanimationsmaßnahmen zu verzichten bzw. Reanimationsmaßnahmen nicht fortzuführen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s10049-021-00894-w) enthalten.

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“…[12][13][14][15][16][17][18] PEEP valves for self-inflating bags (SIBs) exist, but serious concerns have been raised about the ability of these to deliver reliable PEEP. [19][20][21][22] Researchers of 4 randomized controlled trials (RCTs) have investigated PEEP delivered by different devices at birth. [23][24][25][26] Two studies included term in addition to preterm newborns but did not report the effects for term newborns alone.…”

mentioning

confidence: 99%

Positive End-Expiratory Pressure in Newborn Resuscitation Around Term: A Randomized Controlled Trial

et al. 2020

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BACKGROUND: International guidelines for resuscitation recommend using positive end-expiratory pressure (PEEP) during ventilation of preterm newborns. Reliable PEEP-valves for selfinflating bags have been lacking, and effects of PEEP during resuscitation of term newborns are insufficiently studied. The objective was to determine if adding a new PEEP valve to the bag-mask during resuscitation of term and near-term newborns could improve heart rate response.METHODS: This randomized controlled trial was performed at Haydom Lutheran Hospital in Tanzania (September 2016 to June 2018). Helping Babies Breathe-trained midwives performed newborn resuscitation using self-inflating bags with or without a new, integrated PEEP valve. All live-born newborns who received bag-mask ventilation at birth were eligible. Heart rate response measured by ECG was the primary outcome, and clinical outcome and ventilation data were recorded.RESULTS: Among 417 included newborns (median birth weight 3200 g), 206 were ventilated without and 211 with PEEP. We found no difference in heart rate response. Median (interquartile range) measured PEEP in the PEEP group was 4.7 (2.0-5.6) millibar. The PEEP group received lower tidal volumes (4.

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Delivery of positive end-expiratory pressure to preterm lambs using common resuscitation devices

Cited by 7 publications

References 34 publications

Positive end expiratory pressure and respiratory system resistance between self-inflating bag and T-piece resuscitator in a cadaveric piglet lung model

Positive end expiratory pressure and respiratory system resistance between self-inflating bag and T-piece resuscitator in a cadaveric piglet lung model

Versorgung und Reanimation des Neugeborenen nach der Geburt

Positive End-Expiratory Pressure in Newborn Resuscitation Around Term: A Randomized Controlled Trial

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