title: Self-inflating bags versus T-piece resuscitator to deliver sustained inflations in a preterm lamb model.
abstract: OBJECTIVE
  In neonatal resuscitation, the use of a sustained inflation (SI) may facilitate lung aeration. Previous studies comparing different resuscitation devices have shown that one model of self-inflating bag (SIB) could not deliver an SI. We aimed to compare the delivery of an SI using four SIBs with that of a T-piece.
  
  
  METHODS
  In intubated preterm lambs, we compared four models of SIB fitted with a positive end expiratory pressure (PEEP) valve to a T-piece using a gas flow of 8 L/min. Four operators aimed to deliver three SIs of 20 cm H₂O for 30 s. The study was repeated with the PEEP valve removed and again with no flow. We measured duration of SI, average inflation pressure (IP) and analysed the shape of the pressure curves.
  
  
  RESULTS
  204 combinations were analysed. Mean (SD) duration of SI was Ambu 6(2)s, Laerdal 14(8)s, Parker Healthcare 5(1)s, Mayo Healthcare 33(2)s and T-piece 33(1)s. Mean (SD) average IP was Ambu 17(3)cm H₂O, Laerdal 17(3)cm H₂O, Parker Healthcare 12(5)cm H₂O, Mayo Healthcare 21(2)cm H₂O and T-piece 20(0)cm H₂O. Duration of SI and average IP was significantly different between SIBs (all p<0.001). The findings were substantially unchanged when PEEP valve and flow were removed (all p>0.05). Only the Mayo system delivered SIs with duration and average IP not significantly different from the T-piece (p>0.05).
  
  
  CONCLUSIONS
  The performance of the four SIBs tested varied considerably. Some are able to deliver an SI even in the absence of gas flow. This may be useful in a resource-limited setting with no gas supply.
authors.forename: M
authors.initials: M
authors.lastname: Thio
authors.forename: J A
authors.initials: JA
authors.lastname: Dawson
authors.forename: T J
authors.initials: TJ
authors.lastname: Moss
authors.forename: R
authors.initials: R
authors.lastname: Galinsky
authors.forename: A
authors.initials: A
authors.lastname: Rafferty
authors.forename: S B
authors.initials: SB
authors.lastname: Hooper
authors.forename: P G
authors.initials: PG
authors.lastname: Davis
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D004209:Disposable Equipment; D004867:Equipment Design; D005260:Female; D007327:Insufflation / Q000295:instrumentation / Q000379:methods; D023421:Models, Animal; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods; D011247:Pregnancy; D047928:Premature Birth; D012151:Resuscitation / Q000295:instrumentation* / Q000379:methods; D034561:Sheep, Domestic