Delivery of positive end-expiratory pressure to preterm lambs using common resuscitation devices. Issue 1 (13th January 2019)

• Record Type: Journal Article
• Authors: Thio, Marta; Dawson, Jennifer A; Crossley, Kelly J; Moss, Timothy J; Roehr, Charles C; Polglase, Graeme R; Davis, Peter G; Hooper, Stuart B
• Is Part Of: Archives of disease in childhood. Volume 104:Issue 1(2019)
• Page Start: F83
• Publication Date: 2019-01-13
• Subjects: PEEP delivery -- self-inflating bag -- low resource setting -- T-piece -- neonatal resuscitation; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2017-314064
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Background: In neonatal resuscitation, a ventilation device providing positive end-expiratory pressure (PEEP) is recommended. There is limited information about PEEP delivery in vivo, using different models of self-inflating bag (SIB) at different inflation rates and PEEP settings. Methods: We compared PEEP delivery to intubated preterm lambs using four commonly available models of paired SIBs and PEEP valves, with a T-piece, with gas flow of 8 L/min. Peak inspiratory pressure inflations of 30 cmH2 O, combined with set PEEP of 5, 7 and 10 cmH2 O, were delivered at rates of 20, 40 and 60/min. These combinations were repeated without gas flow. We measured mean PEEP, maximum and minimum PEEP, and its difference (PEEP reduction). Results: A total of 3288 inflations were analysed. The mean PEEP delivered by all SIBs was lower than set PEEP (P<0.001), although some differences were <0.5 cmH2 O. In 55% of combinations, the presence of gas flow resulted in increased PEEP delivery (range difference 0.3–2 cmH2 O). The mean PEEP was closer to set PEEP with faster inflation rates and higher set PEEPs. The mean (SD) PEEP reduction was 3.9 (1.6), 8.2 (1.8), 2 (0.6) and 1.1 (0.6) cmH2 O with the four SIBs, whereas it was 0.5 (0.2) cmH2 O with the T-piece. Conclusions: PEEP delivery with SIBs depends on the set PEEP, inflation rate, device model and gas flow. At recommended inflation rates of 60/min, some devices can deliver PEEP close to the set level, although the reduction in PEEP makes some SIBs potentially less effective for lung recruitment than a T-piece.