The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


John T. Gallagher, Sara Bodi; UH Rainbow Babies & ChildrenÂ’s Hospital, Cleveland, OH

Background: Neonatal resuscitation often involves the use of free-flow oxygen delivery as a means of supporting a spontaneously breathing yet cyanotic newborn. The T-piece resuscitator is recognized by the AAP/AHA Neonatal Resuscitation Program (NRP) as an approved device to deliver oxygen in this manner. Current evidence for this application is limited to reports documenting actual oxygen concentrations delivered with the PEEP valve occluded or open. Clinically, respiratory distress can also be treated with prescribed oxygen flows independent of concentration. As a result, the aim of this study is to determine the significance of gas flow variations during free-flow oxygen delivery using a t-piece with PEEP valve occluded as well as open under normal operating conditions. Method: We simulated delivery of free-flow oxygen with a Neopuff t-piece resuscitator (Fisher & Paykel, New Zealand) using three independent disposable circuits by Fisher & Paykel, NeoForce (Ivyland, PA), and Neo Tee (Mercury Medical, Clearwater, FL). Simulated free-flow oxygen delivery was performed as the distal port on the tee of each circuit was connected to a neonatal flow sensor on a Drager Evita XL ventilator (Telford, PA). Flow calculations were observed on the Drager and recorded for three different adjusted PEEP levels (0, 5, 10 cmH2O) and three different set flows (8, 10, 12 Lpm). Paired t-tests were used to compare results of occluded versus open PEEP valve. ANOVA tests were applied to the multiple circuit evaluation. Results: The circuits were evaluated at 18 combinations of set flow, PEEP level, and status of PEEP valve occlusion. There is a statistical difference in flow when the t-piece is occluded versus open, regardless of set flow or PEEP settings (p< 0.05). The difference in delivered flow between occluded and open PEEP valve decreases as set PEEP increases. Further, the difference in delivered flow between open and occluded PEEP valve increases as the set liter flow increases. Finally, choice of circuit brand has no effect on flow variability whether occluded (p=0.079) or open (p=0.76). Conclusion: While previous reports have shown no difference in delivered oxygen concentrations when a t-piece PEEP valve is occluded or open, our results suggest that the flow delivered varies significantly when the PEEP valve is occluded versus open. However, these results are not necessarily suggestive of clinical significance. Sponsored Research - None Occluded Vs. Open: Average Difference in Delivered Flow (Lpm)