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


METHODS
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.
Hawkes
C P
CP
Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork, Ireland.
Oni
O A
OA
Dempsey
E M
EM
Ryan
C A
CA
D004867:Equipment Design; D004869:Equipment Safety / Q000379:methods; D006801:Humans; D007223:Infant; D008365:Manometry; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods