Comparison of Tidal Volumes Delivered With Three T-Piece Resuscitators for Use in Newborns and Infants

Abstract

Background:

Manual ventilation can result in complications caused by under or over ventilating by improper use of manual resuscitators.1,2 T-piece resuscitators have been used in neonates and infants in a variety of settings. While there is a proposed crossover between several types of infant and pediatric resuscitator use at lower flows, a comparison between devices has not been explored to indicate if they can be used equivocally. The purpose of this bench evaluation is to determine if resuscitators deliver similar tidal volumes at the same settings and if all types can be used in this population of patients.

Methods:

A Reusa-Tee, Neo-Tee (Mercury Medical, Clearwater FL), and Neopuff (Fisher & Paykel, Auckland, NZ) circuits were independently attached to an IngMar Medical (Pittsburgh, PA) Neonatal Lung Model with set lung compliance of 1 and 2 mL/cm/H₂O, and a BC Biomedical LS-20001 Smart Lung Infant Simulator with a set lung compliance of 5 mL/cm/H₂O. Using a PEEP +5, frequency of 20 breaths/min, I:E 1:2 and PIP at 20 cm H₂O at a flow of 10 L/min. Tidal volumes were recorded using a pediatric-adult flow sensor attached to a NICO monitor (Respironics, Wallingford, CT) every two min at each setting. Tidal volumes for each resuscitator were analyzed using a paired t-test with a statistical significance set at P<0.01. A comparison between resuscitators was done using Kruskal-Wallis rank sum test. Mean values and standard deviations (SD) are displayed in the table below.

Results:

There was a statistically significant difference in tidal volumes delivered at the same resuscitator settings used at compliances of 1, 2, and 5 mL/cm H₂O, The Neopuff provided lower mean values (and SD) compared to the Neo-Tee and Resusa-tee at lower flows and compliances. At higher compliance, tidal volumes increased with the Resusa-Tee.

Conclusions:

Despite consistent pressure and flow settings used with T-piece resuscitators, delivered tidal volumes vary between resuscitation devices. Evaluation of clinically important differences and outcomes need to be determined.

1. American Academy of Pediatrics; American Heart Association: Textbook of neonatal resuscitation, 6th edition. American Academy of Pediatrics: Elk Grove Village, Ill; 2011. 2. Roehr CC, Kelm M, Fischer HS, et al. Manual ventilation devices in neonatal resuscitation. Tidal volume and positive pressure-provision. Resuscitation 2010;81(2):202-205.

10 lpm 20/5 x 20 Ti 1 sec I:E 1:2

	Neopuff	Neo-Tee	Resusa-Tee
NeoLung1 ml/cmH2O	14 (1.25)	24 (1.89)	20.4 (1.5)
NeoLung2 ml/cm H2O	24.8 (1.75)	35 (3.99)	35.6 (2.24)
Pediatric Lung5 ml/cm H2O	NA	56.9 (2.34)	71.4 (1.69)