title: Neopuff T-piece resuscitator: does device design affect delivered ventilation?
abstract: BACKGROUND
  The T-piece resuscitator (TPR) is in common use worldwide to deliver positive pressure ventilation during resuscitation of infants <10 kg. Ease of use, ability to provide positive end-expiratory pressure (PEEP), availability of devices inbuilt into resuscitaires and cheaper disposable options have increased its popularity as a first-line device for term infant resuscitation. Research into its ventilation performance is limited to preterm infant and animal studies. Efficacy of providing PEEP and the use of TPR during term infant resuscitation are not established.
  
  
  OBJECTIVE
  The aim of this study is to determine if delivered ventilation with the Neopuff brand TPR varied with differing (preterm to term) test lung compliances (Crs) and set peak inspiratory pressures (PIP).
  
  
  METHODS
  A single operator experienced in newborn resuscitation provided positive pressure ventilation in a randomised sequence to three different Crs models (0.5, 1 and 3 mL/cmH2O) at three different set PIP (20, 30 and 40 cmH2O). Set PEEP (5 cmH2O), gas flow rate and inflation rate were the same for each sequence.
  
  
  RESULTS
  A total of 1087 inflations were analysed. The delivered mean PEEP was Crs dependent across set PIP range, rising from 4.9 to 8.2 cmH2O. At set PIP 40 cmH2O and Crs 3 mL/cmH2O, the delivered mean PIP was significantly lower at 35.3 cmH2O.
  
  
  CONCLUSIONS
  As Crs increases, the Neopuff TPR can produce clinically significant levels of auto-PEEP and thus may not be optimal for the resuscitation of term infants with healthy lungs.
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia.|Faculty of Engineering and Information Technologies, BMET Institute, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Murray
authors.initials: M
authors.lastname: Hinder
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia.|Department of Paediatrics and Child Health, Sydney University, Westmead, New South Wales, Australia.
authors.forename: Pranav
authors.initials: P
authors.lastname: Jani
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia.|Department of Paediatrics and Child Health, Sydney University, Westmead, New South Wales, Australia.
authors.forename: Archana
authors.initials: A
authors.lastname: Priyadarshi
authors.affiliation: Faculty of Engineering and Information Technologies, BMET Institute, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Alistair
authors.initials: A
authors.lastname: McEwan
authors.affiliation: Neonatal Intensive Care, Westmead Hospital, Westmead, New South Wales, Australia.|Department of Paediatrics and Child Health, Sydney University, Westmead, New South Wales, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Tracy
mesh_terms: D004867:Equipment Design; D006801:Humans; D007224:Infant Care / Q000295:instrumentation / Q000379:methods; D007231:Infant, Newborn / Q000502:physiology*; D001239:Inhalation / Q000502:physiology; D008170:Lung Compliance / Q000502:physiology; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods; D011897:Random Allocation; D012151:Resuscitation / Q000295:instrumentation* / Q000379:methods; D013990:Tidal Volume / Q000502:physiology
keywords: Neopuff; Newborn; Resuscitation; T-piece; auto PEEP