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Changing gas flow during neonatal resuscitation: A manikin study.
MedLine Citation:
PMID:  21444142     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: When using a T-piece device, resuscitators may try to improve airway pressures by increasing gas flow instead of correcting face mask position. AIM: To measure the effects of changing gas flow during positive pressure ventilation (PPV) on peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), expiratory tidal volume (V(Te)) and mask leak. METHODS: Using a Neopuff T-piece device, 20 neonatal staff members delivered PPV to a modified, leak-free manikin. Resuscitation parameters were recorded. Study A: PPV for 4min at PIP 30cm H(2)O and PEEP 5cm H(2)O. Each minute gas flow was increased (5, 8, 10, and 15L/min). PIP and PEEP settings were unchanged. Study B: same pressure settings; PPV for 1min with 5, 8, 10, and 15L/min in a random order, at a rate of ∼60/min. The pressures were adjusted to maintain the same PIP and PEEP after each flow change. RESULTS: Study A: As gas flow increased (5, 8, 10 and 15L/min) the median PEEP increased from 4.7 to 26.4cm H(2)O (p<0.002). Median V(Te) decreased from 10.0 to 0.8mL (p<0.001). PIP increased slightly from 30cm H(2)O to 36cm H(2)O at 15L/min (p<0.005). Mask leak increased from 14% to 98% (p<0.001) because mask pressure increased. Study B: when PIP and PEEP were maintained there were no significant differences in V(Te) (p=0.42) or mask leak (p=0.51) with changing gas flow. CONCLUSION: During PPV increasing gas flow dramatically increased PEEP and mask leak and in consequence reduced V(Te). Gas flow should rarely be changed during T-piece resuscitation.
Authors:
Kim Schilleman; Georg M Schmölzer; Omar C O F Kamlin; Colin J Morley; Arjan B Te Pas; Peter G Davis
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-26
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
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