The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Kathleen Deakins1, Timothy Myers1

Introduction: T-piece (TP) resuscitation is an alternative method for manually ventilating neonates at caregiver-controlled frequencies (f), with stable and reproducible peak inspiratory (PIP) and expiratory pressures (PEEP) (Kattwinkel, J. Textbook of Neonatal Resuscitation 2006, 4: 3-54). Institutional guidelines were created at our hospital to establish settings for manual ventilation. The purpose of this study was to determine if caregiver-initiated manual ventilation is consistent with established institutional guidelines during daily clinical practice.

Methods: Respiratory therapists and nurses were blindly observed during 40 random manual ventilation events performed using the Neopuff (Fisher and Paykel Healthcare, Auckland NZ) on intubated patients in the Neonatal Intensive Care Unit (NICU). Caregivers had been instructed and trained to use the guidelines to set the Neopuff PIP at 2 cm H20 above the PIP on the ventilator and match the PEEP from the ventilator setting. The desired frequency was intended to equal the set ventilator frequency. During the blinded observations, delivered PIP and PEEP were recorded from the Neopuff manometer while frequency was counted manually and timed over one minute using a standard stop watch. Patients on high frequency ventilation were excluded from this evaluation. Differences between set parameters and observed practice for PIP, PEEP and frequency were reported as mean values and standard deviations below.

Results: During the blinded observations, 97.5% of the observed frequencies were above the guideline target, while only 2.5% were exact. 25% of PIP levels met the exact guideline targets, while 20% were higher and 55% were lower than the guideline. PEEP levels were exact 90% of the time. Descriptive statistics are listed in the table below for the set and measured frequency, PIP and PEEP observations. Standard error and 95% confidence intervals for the mean values are calculated. The average difference (measured-set) is also displayed.

Conclusion: As with prior studies using T-Piece resuscitators, set and controlled parameters PIP and PEEP are precise and with an acceptable error range of established guidelines. Caregiver initiated and controlled respiratory frequencies are neither accurate nor precise and may dramatically alter ventilation parameters in infants.