Effect of T-Piece Resuscitator versus Self Inflating Bag on Arterial CO2 Levels in Preterm Neonates

Abstract

Objective To compare the effect of self-inflating bag (SIB) vs. T-piece resuscitator (TPR) on PaCO 2 levels, when used for brief manual ventilation during administration of first dose of surfactant. Methods Preterm neonates were randomized to receive positive pressure ventilation with either self-inflating bag or T-piece resuscitator during administration of first dose of surfactant. Arterial blood gases were obtained at baseline and 1 h after the intervention. Primary outcome was the mean change in PaCO 2 levels 1 h after the intervention. Results Eighty neonates were enrolled (40 in each group). The drop in PaCO 2 at 1 h was significantly greater in the self inflating bag group as compared to the T-piece resuscitator group [8.96 ± 9.06 mmHg vs. 1.37 ± 9.06 mmHg, Mean difference = 7.58 mmHg, (95% CI: 3.78 to 11.4); P < 0.01]. The PaCO 2 change was also statistically significant in the subgroup of infants that required only non-invasive ventilation. The need for second dose of surfactant was higher in the self-inflating bag group [77% vs. 55%, RR-1.41 (95% CI: 1.02 to 1.94); P = 0.03]. Conclusions T-piece resuscitator results in smaller reduction in PaCO 2 levels compared to the self inflating bag, when used for brief manual ventilation during surfactant administration.

Providing Positive End-Expiratory Pressure during Neonatal Resuscitation: A Meta-analysis

“…After deduplication, 2,129 articles were assessed for potential eligibility and 14 of them were retrieved as full-texts. Subsequently, 4 studies were excluded since 3 of them did not report any of the outcomes of interest [33][34][35], while 1 study did not evaluate neonates at birth [36]. As a result, 10 studies [21,[37][38][39][40][41][42][43][44][45] were included in the meta-analysis, comprising 4,268 neonates (2,925 in the PEEP group and 1,343 in the no PEEP group).…”

“…Subsequently, four studies were excluded since three of them did not report any of the outcomes of interest, [33][34][35] while one study did not evaluate neonates at birth. 36 As a result, 10 studies 21,[37][38][39][40][41][42][43][44][45] were included in the meta-analysis, comprising 4,268 neonates (2,925 in the PEEP group and 1,343 in the no PEEP group). The study selection process is illustrated in the PRISMA flowchart (►Fig.…”

T-Piece Resuscitator and Better Arterial CO2 Levels: An Optimistic Future

“…In this issue of the journal, Jeevan et al [4] have compared effect of SIB with TPR in fluctuation of arterial CO 2 (PaCO 2 ) levels at 1 h and 6 h of surfactant administration in preterm neonates with respiratory distress syndrome (RDS). In this open labelled RCT, the authors have randomly assigned 80 preterm neonates meeting the criteria for surfactant administration via INSURE technique (RDS with FiO 2 requirements of > 35% and PEEP ≥ 6 cm H 2 O) to receive PPV either by SIB or TPR and compared the mean change in PaCO 2 levels 1 h (primary outcome) and 6 h after the intervention.…”