Potential hazard of the Neopuff T-piece resuscitator in the absence of flow limitation

Abstract

Objective: (1) To assess peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP) and maximum pressure relief (P max ) at different rates of gas flow, when the Neopuff had been set to function at 5 l/min. (2) To assess maximum PIP and PEEP at a flow rate of 10 l/min with a simulated air leak of 50%. Design: 5 Neopuffs were set to a PIP of 20, PEEP of 5 and P max of 30 cm H 2 O at a gas flow of 5 l/min. PIP, PEEP and P max were recorded at flow rates of 10, 15 l/min and maximum flow. Maximum achievable pressures at 10 l/ min gas flow, with a 50% air leak, were measured. Results: At gas flow of 15 l/min, mean PEEP increased to 20 (95% CI 20 to 21), PIP to 28 (95% CI 28 to 29) and the P max to 40 cm H 2 O (95% CI 38 to 42). At maximum flow (85 l/min) a PEEP of 71 (95% CI 51 to 91) and PIP of 92 cm H 2 O (95% CI 69 to 115) were generated. At 10 l/ min flow, with an air leak of 50%, the maximum PEEP and PIP were 21 (95% CI 19 to 23) and 69 cm H 2 O (95% CI 66 to 71). Conclusions: The maximum pressure relief valve is overridden by increasing the rate of gas flow and potentially harmful PIP and PEEP can be generated. Even in the presence of a 50% gas leak, more than adequate pressures can be provided at 10 l/min gas flow. We recommend the limitation of gas flow to a rate of 10 l/min as an added safety mechanism for this device.

Low versus High Gas Flow Rate for Respiratory Support of Infants at Birth: A Manikin Study

“…A flow of 5 liters/min does not appear to limit the maximum PIP setting, but limited the maximum PEEP setting to 3.6 cm H 2 O. This is in contrast with a previous study [11] showing that a PEEP of 5 cm H 2 O could be reached with a flow of 5 liters/min. However, Hawkes et al [11] did not measure the delivered pressures as these were measured with manometer intrinsic in the Neopuff.…”

“…This is in contrast with a previous study [11] showing that a PEEP of 5 cm H 2 O could be reached with a flow of 5 liters/min. However, Hawkes et al [11] did not measure the delivered pressures as these were measured with manometer intrinsic in the Neopuff. The intrinsic pressures do not reflect the actual PEEP as the resistance of the tubing can lead to some reduction in the delivered pressures.…”

Leak during Manual Neonatal Ventilation and Its Effect on the Delivered Pressures and Volumes: An in vitro Study

“…Hawkes et al [21] and Schmölzer et al [22] have compared the SIB and the Neopuff with regard to the effect of different flow rates on the applied PIP and PEEP. Both groups have shown that an increase in flow alters PIP and PEEP.…”

Ventilación del recién nacido: comparación entre un reanimador con pieza en t y bolsas autoinflables en un simulador de neonato prematuro

“…7 Se ha observado también que un incremento del flujo del gas puede anular la válvula de control de presión de la pieza en T y sobrepasar en niveles peligrosos la presión máxima administrada y la PEEP, a menos que se ajuste este parámetro con anticipación. 8 A pesar de la amplia utilización, tanto de la bolsa autoinflable como del reanimador con pieza en T, la evidencia sobre cuál es el dispositivo óptimo para suministrar ventilación con presión positiva (VPP) para reanimación al recién nacido en sala de partos es aún limitada. 9 Los objetivos del estudio fueron: 1-Comparar la precisión en la administración de presión positiva y frecuencia respiratoria en un modelo de reanimación neonatal entre los siguientes dispositivos: una BAI de 240 ml (BAI 240), otra de 450 ml (BAI 450) y un reanimador con pieza en T (NP), con una máscara facial y un tubo endotraqueal (TET) como interfaces.…”