T-piece resuscitators: how do they compare?

2018 ◽  
Vol 104 (2) ◽  
pp. F122-F127 ◽  
Author(s):  
Murray Hinder ◽  
Alistair McEwan ◽  
Thomas Drevhammer ◽  
Snorri Donaldson ◽  
Mark Brian Tracy
Keyword(s):  
Bench Test ◽  
Positive Pressure ◽  
Important Variation ◽  
Test Study ◽  
Single Operator ◽  
Design Characteristics ◽  
Ventilation Performance ◽  
Inadvertent Peep ◽  
Preterm Newborns ◽  
Set Value

BackgroundThe T-piece resuscitator (TPR) has seen increased use as a primary resuscitation device with newborns. Traditional TPR design uses a high resistance expiratory valve to produce positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) at resuscitation. A new TPR device that uses a dual flow ratio valve (fluidic flip) to produce PEEP/CPAP is now available (rPAP). We aimed to compare the measured ventilation performance of different TPR devices in a controlled bench test study.Design/methodsSingle operator provided positive pressure ventilation to an incremental testlung compliance (Crs) model (0.5–5 mL/cmH2O) with five different brands of TPR device (Atom, Neopuff, rPAP, GE Panda warmer and Draeger Resuscitaire). At recommended peak inflation pressure (PIP) 20 cmH2O, PEEP of 5 cmH2O and rate of 60 inflations per minute.Results1864 inflations were analysed. Four of the five devices tested demonstrated inadvertent elevations in mean PEEP (5.5–10.3 cmH2O, p<0.001) from set value as Crs was increased, while one device (rPAP) remained at the set value. Measured PIP exceeded the set value in two infant warmer devices (GE and Draeger) with inbuilt TPR at Crs of 0.5 (24.5 and 23.5 cmH2O, p<0.001). Significant differences were seen in tidal volumes across devices particularly at higher Crs (p<0.001).ConclusionsResults show important variation in delivered ventilation from set values due to inherent TPR device design characteristics with a range of lung compliances expected at birth. Device-generated inadvertent PEEP and overdelivery of PIP may be clinically deleterious for term and preterm newborns or infants with larger Crs during resuscitation.

T-piece resuscitators: can they provide safe ventilation in a low compliant newborn lung?

2020 ◽  
Vol 106 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Murray Kenneth Hinder ◽  
Thomas Drevhammar ◽  
Snorri Donaldsson ◽  
Matthew Boustred ◽  
Matthew Crott ◽  
...  
Keyword(s):  
Gas Flow ◽  
Lung Compliance ◽  
Lung Model ◽  
Bench Test ◽  
Positive Pressure ◽  
Test Model ◽  
Inflation Pressure ◽  
Emergency Rooms ◽  
Test Lung ◽  
Single Operator

BackgroundT-piece resuscitators (TPRs) are used for primary newborn resuscitation in birthing and emergency rooms worldwide. A recent study has shown spikes in peak inflation pressure (PIP) over set values with two brands of TPRs inbuilt into infant warmer/resuscitation platforms. We aimed to compare delivered ventilation between two TPR drivers with inflation pressure spikes to a standard handheld TPR in a low test lung compliance (Crs), leak-free bench test model.MethodsA single operator provided positive pressure ventilation to a low compliance test lung model (Crs 0.2–1 mL/cmH2O) at set PIP of 15, 25, 35 and 40 cmH2O. Two TPR devices with known spikes (Draeger Resuscitaire, GE Panda) were compared with handheld Neopuff (NP). Recommended settings for positive end-expiratory pressure (5 cmH2O), inflation rate of 60/min and gas flow rate 10 L/min were used.Results2293 inflations were analysed. Draeger and GE TPR drivers delivered higher mean PIP (Panda 18.9–49.5 cmH2O; Draeger 21.2–49.2 cmH2O and NP 14.8–39.9 cmH2O) compared with set PIP and tidal volumes (TVs) compared with the NP (Panda 2.9–7.8 mL; Draeger 3.8–8.1 mL; compared with NP 2.2–6.0 mL), outside the prespecified acceptable range (±10% of set PIP and ±10% TV compared with NP).ConclusionThe observed spike in PIP over set values with Draeger and GE Panda systems resulted in significantly higher delivered volumes compared with the NP with identical settings. Manufacturers need to address these differences. The effect on patient outcomes is unknown.

A new device to treat mitral valve regurgitation: a proof of concept in bench test study

2021 ◽  
Vol 45 (3) ◽  
pp. 197-206
Author(s):  
Giovanni Alfonso Chiariello ◽  
Saimir Kuci ◽  
Guglielmo Saitto ◽  
Massimo Massetti ◽  
Ottavio Alfieri ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Regurgitation ◽  
Bench Test ◽  
Proof Of Concept ◽  
Valve Regurgitation ◽  
New Device ◽  
Test Study

A Bench Test Study of Port Fuel Injection Fouling

2008 ◽  
Author(s):  
Peter W. Hou ◽  
Thomas W. Nichols ◽  
Keith T. Miller ◽  
Joshua J. Bennett
Keyword(s):  
Fuel Injection ◽  
Bench Test ◽  
Port Fuel Injection ◽  
Test Study

Aorfix Stent Graft for Abdominal Aortic Aneurysms Reduces the Risk of Proximal Type 1 Endoleak in Angulated Necks: Bench-Test Study

Vascular ◽  
2005 ◽  
Vol 13 (06) ◽  
pp. 321 ◽  
Author(s):  
Jean-Noël Albertini ◽  
Maria-Angela DeMasi ◽  
Jan Macierewicz ◽  
Redouane El Idrissi ◽  
Brian R. Hopkinson ◽  
...  
Keyword(s):  
Stent Graft ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Bench Test ◽  
Test Study ◽  
Abdominal Aortic

A novel adaptive control system for noisy pressure-controlled ventilation: a numerical simulation and bench test study

2009 ◽  
Vol 36 (1) ◽  
pp. 164-168 ◽  
Author(s):  
Alessandro Beda ◽  
Peter M. Spieth ◽  
Thomas Handzsuj ◽  
Paolo Pelosi ◽  
Nadja C. Carvalho ◽  
...  
Keyword(s):  
Numerical Simulation ◽  
Adaptive Control ◽  
Control System ◽  
Bench Test ◽  
Adaptive Control System ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Test Study ◽  
Pressure Controlled

scholarly journals Newborn self-inflating manual resuscitators: precision robotic testing of safety and reliability

2018 ◽  
pp. fetalneonatal-2018-315391 ◽  
Author(s):  
Mark B Tracy ◽  
Robert Halliday ◽  
Sally K Tracy ◽  
Murray K Hinder
Keyword(s):  
Low Income ◽  
Coefficient Of Variation ◽  
Repeated Measures ◽  
Newborn Infants ◽  
International Standards ◽  
Lung Model ◽  
Bench Test ◽  
Positive Pressure ◽  
Human Hand ◽  
Middle Income

AimA controlled bench test was undertaken to determine the performance variability among a range of neonatal self-inflating bags (SIB) compliant with current International Standards Organisation (ISO).IntroductionUse of SIB to provide positive pressure ventilation during newborn resuscitation is a common emergency procedure. The United Nations programmes advocate increasing availability of SIB in low-income and middle-income nations and recommend devices compliant with ISO. No systematic study has evaluated variance in different models of neonatal SIB.Methods20 models of SIB were incrementally compressed by an automated robotic device simulating the geometry and force of a human hand across a range of precise distances in a newborn lung model. Significance was calculated using analysis of variance repeated measures to determine the relationship between distance of SIB compression and delivered ventilation. A pass/fail was derived from a composite score comprising: minimum tidal volume; coefficient of variation (across all compression distances); peak pressures generated and functional compression distance.ResultsTen out of the 20 models of SIB failed our testing methodology. Two models could not provide safe minimum tidal volumes (2.5–5 mL); six models exceeded safety inflation pressure limit >45 cm H2O, representing 6% of their inflations; five models had excessive coefficient of variation (>30% averaged across compression distances) and three models did not deliver inflation volumes >2.5 mL until approximately 50% of maximum bag compression distance was reached. The study also found significant intrabatch variability and forward leakage.ConclusionCompliance of SIBs with ISO standards may not guarantee acceptable or safe performance to resuscitate newborn infants.

Bench-Test Study Subgroup Report Synopsis

2012 ◽  
Vol 121 (8) ◽  
pp. 27-29
Author(s):  
Nelson Meacham ◽  
Tom Scott
Keyword(s):  
Bench Test ◽  
Test Study

scholarly journals Comparative assessment of several automatic CPAP devices' responses: a bench test study

2015 ◽  
Vol 1 (1) ◽  
pp. 00031-2015 ◽  
Author(s):  
Valentina Isetta ◽  
Daniel Navajas ◽  
Josep M. Montserrat ◽  
Ramon Farré
Keyword(s):  
Breathing Pattern ◽  
Sleep Stage ◽  
Sleep Apnoea ◽  
Bench Test ◽  
Maximum Pressure ◽  
Breathing Patterns ◽  
Test Study ◽  
Obstructive Sleep ◽  
Computer Controlled ◽  
Nasal Pressure

Automatic continuous positive airway pressure (APAP) devices adjust the delivered pressure based on the breathing patterns of the patient and, accordingly, they may be more suitable for patients who have a variety of pressure demands during sleep based on factors such as body posture, sleep stage or variability between nights. Devices from different manufacturers incorporate distinct algorithms and may therefore respond differently when subjected to the same disturbed breathing pattern. Our objective was to assess the response of several currently available APAP devices in a bench test.A computer-controlled model mimicking the breathing pattern of a patient with obstructive sleep apnoea (OSA) was connected to different APAP devices for 2-h tests during which flow and pressure readings were recorded. Devices tested were AirSense 10 (ResMed), Dreamstar (Sefam), Icon (Fisher & Paykel), Resmart (BMC), Somnobalance (Weinmann), System One (Respironics) and XT-Auto (Apex). Each device was tested twice.The response of each device was considerably different. Whereas some devices were able to normalise breathing, in some cases exceeding the required pressure, other devices did not eliminate disturbed breathing events (mainly prolonged flow limitation). Mean and maximum pressures ranged 7.3–14.6 cmH2O and 10.4–17.9 cmH2O, respectively, and the time to reach maximum pressure varied from 4.4 to 96.0 min.Each APAP device uses a proprietary algorithm and, therefore, the response to a bench simulation of OSA varied significantly. This must be taken into account for nasal pressure treatment of OSA patients and when comparing results from clinical trials.

scholarly journals Neonatal Resuscitation With T-Piece Systems: Risk of Inadvertent PEEP Related to Mechanical Properties

2021 ◽  
Vol 9 ◽  
Author(s):  
Thomas Drevhammar ◽  
Markus Falk ◽  
Snorri Donaldsson ◽  
Mark Tracy ◽  
Murray Hinder
Keyword(s):  
Endotracheal Tube ◽  
Gas Flow ◽  
Airway Resistance ◽  
Neonatal Resuscitation ◽  
Positive Pressure ◽  
Term Infants ◽  
Time Constants ◽  
Expiratory Time ◽  
Four Levels ◽  
Inadvertent Peep

Background: Resuscitation of infants using T-piece resuscitators (TPR) allow positive pressure ventilation with positive end-expiratory pressure (PEEP). The adjustable PEEP valve adds resistance to expiration and could contribute to inadvertent PEEP. The study indirectly investigated risk of inadvertent peep by determining expiratory time constants. The aim was to measure system expiratory time constants for a TPR device in a passive mechanical model with infant lung properties.Methods: We used adiabatic bottles to generate four levels of compliance (0.5–3.4 mL/cm H2O). Expiratory time constants were recorded for combinations of fresh gas flow (8, 10, 15 L/min), PEEP (5, 8, 10 cm H2O), airway resistance (50, 200 cm H2O/L/sec and none), endotracheal tube (none, size 2.5, 3.0, 3.5) with a peak inflation pressure of 15 cm H2O above PEEP.Results: Low compliances resulted in time constants below 0.17 s contrasting to higher compliances where the expiratory time constants were 0.25–0.81 s. Time constants increased with increased resistance, lower fresh gas flows, higher set PEEP levels and with an added airway resistance or endotracheal tube.Conclusions: The risk of inadvertent PEEP increases with a shorter time for expiration in combination with a higher compliance or resistance. The TPR resistance can be reduced by increasing the fresh gas flow or reducing PEEP. The expiratory time constants indicate that this may be clinically important. The risk of inadvertent PEEP would be highest in intubated term infants with highly compliant lungs. These results are useful for interpreting clinical events and recordings.

scholarly journals Assessment of ability of medical and obstetric students to achieve adequate positive pressure ventilation using basic neonatal resuscitation manikins

2021 ◽  
Vol 82 (3) ◽  
Author(s):  
Blanca Solis-Chimoy ◽  
Carlos A. Delgado ◽  
Roberto Shimabuku ◽  
Milagro Raffo
Keyword(s):  
Clinical Practice ◽  
Undergraduate Students ◽  
Positive Pressure Ventilation ◽  
Neonatal Resuscitation ◽  
Theory And Practice ◽  
Health Science ◽  
Positive Pressure ◽  
Clinical Activity ◽  
Ventilation Performance ◽  
Practice Assessment

Introduction. The ability to perform adequate positive pressure ventilation is necessary for neonatal clinical practice. However, there are few studies on the achievements of undergraduate students on this task. It is necessary to assess health science students’ adequate positive pressure ventilation because it is vital at the beginning of their clinical activity. Objective. To evaluate the cognitive and procedural ability related to adequate positive pressure ventilation performed by 6th year medicine students and 4th year obstetrics students at a public university in Lima, Peru. Methods. We surveyed 78 medical and obstetric students in their last years of studies within six months of taking a course on neonatal resuscitation that included positive pressure ventilation theory and practice. Participants voluntarily agreed to participate in this study. Previously, we validated the survey by asking three experienced neonatologists for their expert judgments on improving the survey. The survey consists of three theoretical questions as a cognitive assessment and three practice assessment criteria qualified by observing performance using neonatal manikins. Results. Medicine students had a better practical ability (p <0.001) than obstetrics students, and obstetrics students presented better theoretical knowledge (p = 0.019). However, both groups achieved limited performance within six months of taking the neonatal clinical practice course as 21.8% of all students passed both the theoretical and practical parts of this study. Conclusion. Participants from both schools require further training alternatives to achieve adequate positive pressure ventilation performance.

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