title: Time to adjust to changes in ventilation settings varies significantly between different T-piece resuscitators, self-inflating bags, and manometer equipped self-inflating bags.
abstract: OBJECTIVE
  Resuscitation guidelines give no preference over use of self-inflating bags (SIBs) or T-piece resuscitators (TPR) for manual neonatal ventilation. We speculated that devices would differ significantly regarding time required to adjust to changed ventilation settings.
  
  
  METHODS
  This was a laboratory study. Time to adjust from baseline peak inflation pressure (PIP) (20 cmH2O) to target PIP (25 and 40 cmH2O), ability to adhere to predefined ventilation settings (PIP, PEEP, and inflation rate [IR]), and the variability within and between operators were assessed for a SIB without manometer, SIB with manometer (SIBM), and two TPRs.
  
  
  RESULTS
  Adjustment time was significantly longer with TPRs, compared with SIB and SIBM. The SIBM and TPRs were < 5% (median) off target PIP, and the SIB was 14% off target PIP. Significant variability between operators (interquartile range [IQR]: 71%) was seen with SIBs.
  
  
  CONCLUSIONS
  PIP adjustment takes longer with TPRs, compared with SIB/SIBM. TPRs and SIBM allow satisfactory adherence to ventilation parameters. SIBs should only be used with manometer attached.
authors.affiliation: Department of Neonatology, Charité University Medical Center, Berlin, Germany.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Hartung
authors.affiliation: Department of Neonatology, Charité University Medical Center, Berlin, Germany.
authors.forename: Simone K
authors.initials: SK
authors.lastname: Dold
authors.affiliation: Department of Newborn Research, The Royal Women's Hospital, Melbourne, Australia.
authors.forename: Marta
authors.initials: M
authors.lastname: Thio
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: tePas
authors.affiliation: Department of Neonatology, Charité University Medical Center, Berlin, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Schmalisch
authors.affiliation: Department of Neonatology, Charité University Medical Center, Berlin, Germany.
authors.forename: Charles Christoph
authors.initials: CC
authors.lastname: Roehr
mesh_terms: D000399:Air Pressure; D006801:Humans; D007231:Infant, Newborn; D008348:Manikins; D008365:Manometry; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods; D012151:Resuscitation / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors