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Charles Christoph Roehr - One of the best experts on this subject based on the ideXlab platform.
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t piece Resuscitator or self inflating bag during neonatal resuscitation a scoping review
Pediatric Research, 2020Co-Authors: Charles Christoph Roehr, Peter G Davis, Gary Weiner, Jonathan J Wyllie, Myra H Wyckoff, Daniele TrevisanutoAbstract:Background To identify the evidence for administering positive pressure ventilation (PPV) to infants at birth by either T-piece Resuscitator (TPR) or self-inflating bag (SIB), and to determine whether a full systematic review (SR) is warranted. Methods Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews, eligible studies included peer-reviewed human studies, prospectively or retrospectively comparing a TPR vs. SIB for administering PPV at birth. Databases searched were OVID Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials. Review Manager software was used for the data analysis. Results Following electronic literature search and review, data from four eligible studies (3 RCT and 1 observational study), enrolling a total of 2889 patients, were included. Studies differed regarding the investigated populations, reported outcomes and came from different geographical areas. In particular for preterm infants, use of TPR for providing PPV may improve survival, result in fewer intubations at birth and decrease the incidence of bronchopulmonary dysplasia. Conclusions This scoping review identified two new studies with substantive new evidence, pointing towards improved survival, decreased bronchopulmonary dysplasia and fewer intubations at birth, in particular among preterm infants treated with TPR. Full SR of the literature is advised. Impact This scoping review identified studies comparing TPR vs. SIB for respiratory support of newborn infants previously not included in the International Liaison Committee on Resuscitation (ILCOR) recommendations.Our review found substantive new evidence highlighting that device choice may impact the outcomes of compromised newborn infants'.This scoping review stipulates the need for full SR and updated meta-analysis of studies investigating supportive equipment for stabilizing infants at birth in order to inform ILCOR treatment recommendations.
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Accuracy of a disposable compared to a non-disposable infant T-piece Resuscitator
European Journal of Pediatrics, 2014Co-Authors: Vera B. Krabbe, Jeroen J. Vonderen, Charles Christoph RoehrAbstract:Both disposable and non-disposable T-piece Resuscitator (TPR) devices are used. Accuracy of the disposable and non-disposable infant TPR was compared. Peak inspiratory pressures (PIP) and positive end-expiratory pressures (PEEP) were measured during ventilation of a test lung. Measured PIP ±1 cmH_2O and PEEP ±0.5 cmH_2O of the desired pressures were considered acceptable. We tested the following: (A) Accuracy of setting pressures using built-in manometers of three disposable TPRs, (B) Minimal and maximal PIP and PEEP levels for the non-disposable and disposable TPR were measured using different gas flow rates, and (C) Accuracy of 25 caregivers setting pressures (PIP 25 cmH_2O and PEEP 5 cmH_2O). The results of the tests performed were as follows: (A) With pressures set: PIP 20, 25, 30, and 40 cmH_2O and PEEP 5–8 cmH_2O with 1 cmH_2O stepwise increment, measured PIPs and PEEPs were in acceptable range. (B) At gas flow rates 5, 8, 10, and 15 L/min (disposable vs. non-disposable), min-max PIP were 4.0–43.2 vs. 2.9–77.1 cmH_2O and min-max PEEP were 0.3–22.3 and 0.6–59.7 cmH_2O. (C) Set PIP (cmH_2O) by participants using disposable vs. non-disposable TPR was 25.8 (0.8) vs. 25.9 (1.3) (ns). PEEP was 5.4(0.5) vs. 4.7(0.5); p
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accuracy of a disposable compared to a non disposable infant t piece Resuscitator
European Journal of Pediatrics, 2014Co-Authors: Vera B. Krabbe, Charles Christoph Roehr, Jeroen J. Van Vonderen, Arjan Te B. PasAbstract:Both disposable and non-disposable T-piece Resuscitator (TPR) devices are used. Accuracy of the disposable and non-disposable infant TPR was compared. Peak inspiratory pressures (PIP) and positive end-expiratory pressures (PEEP) were measured during ventilation of a test lung. Measured PIP ±1 cmH2O and PEEP ±0.5 cmH2O of the desired pressures were considered acceptable. We tested the following: (A) Accuracy of setting pressures using built-in manometers of three disposable TPRs, (B) Minimal and maximal PIP and PEEP levels for the non-disposable and disposable TPR were measured using different gas flow rates, and (C) Accuracy of 25 caregivers setting pressures (PIP 25 cmH2O and PEEP 5 cmH2O). The results of the tests performed were as follows: (A) With pressures set: PIP 20, 25, 30, and 40 cmH2O and PEEP 5–8 cmH2O with 1 cmH2O stepwise increment, measured PIPs and PEEPs were in acceptable range. (B) At gas flow rates 5, 8, 10, and 15 L/min (disposable vs. non-disposable), min-max PIP were 4.0–43.2 vs. 2.9–77.1 cmH2O and min-max PEEP were 0.3–22.3 and 0.6–59.7 cmH2O. (C) Set PIP (cmH2O) by participants using disposable vs. non-disposable TPR was 25.8 (0.8) vs. 25.9 (1.3) (ns). PEEP was 5.4(0.5) vs. 4.7(0.5); p < 0.001. Conclusion: The accuracy of the disposable TPR is comparable to that of the non-disposable TPR.
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do we deliver the pressures we intend to when using a t piece Resuscitator
PLOS ONE, 2013Co-Authors: Evelien Roegholt, Charles Christoph Roehr, Jeroen J. Van Vonderen, Frans J. Walther, Arjan Te B. PasAbstract:Background A T-piece Resuscitator (TPR) uses a built-in manometer to set the inflation pressures, but we are not informed what pressures are actually delivered distally. Aim of this study was to measure the proximal and distal pressures under different gas conditions when using a TPR.
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Equipment and operator training denote manual ventilation performance in neonatal resuscitation.
American Journal of Perinatology, 2010Co-Authors: Charles Christoph Roehr, Marcus Kelm, Hans Proquitté, Gerd SchmalischAbstract:High peak inspiratory pressure (PIP) and tidal volume (V(T)) from manual ventilation are hazardous to the neonatal lung. We investigated the influence of operator training on the extent of applied PIP and V(T) between two manual ventilation devices. We performed a prospective, crossover study of 84 medical professionals using a neonatal mannequin. Participants were classified into four groups, according to experience in neonatal resuscitation and previous training in manual ventilation. Provision of PIP, V(T), and inspiratory time (Ti) were compared between groups and equipment used, either a self-inflating bag (SI-bag) or a T-piece Resuscitator (Neopuff). Using SI-bags, operator training significantly affected provision of PIP ( P 0.001 for PIP and V(T)). Operator training level and device-specific experience had a significant impact on PIP and V(T) provision when using SI-bags for manual ventilation. For operators with no specific training in manual ventilation, use of T-piece devices is advised to control for excessive PIP and V(T) application.
Gary Weiner - One of the best experts on this subject based on the ideXlab platform.
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t piece Resuscitator or self inflating bag during neonatal resuscitation a scoping review
Pediatric Research, 2020Co-Authors: Charles Christoph Roehr, Peter G Davis, Gary Weiner, Jonathan J Wyllie, Myra H Wyckoff, Daniele TrevisanutoAbstract:Background To identify the evidence for administering positive pressure ventilation (PPV) to infants at birth by either T-piece Resuscitator (TPR) or self-inflating bag (SIB), and to determine whether a full systematic review (SR) is warranted. Methods Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews, eligible studies included peer-reviewed human studies, prospectively or retrospectively comparing a TPR vs. SIB for administering PPV at birth. Databases searched were OVID Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials. Review Manager software was used for the data analysis. Results Following electronic literature search and review, data from four eligible studies (3 RCT and 1 observational study), enrolling a total of 2889 patients, were included. Studies differed regarding the investigated populations, reported outcomes and came from different geographical areas. In particular for preterm infants, use of TPR for providing PPV may improve survival, result in fewer intubations at birth and decrease the incidence of bronchopulmonary dysplasia. Conclusions This scoping review identified two new studies with substantive new evidence, pointing towards improved survival, decreased bronchopulmonary dysplasia and fewer intubations at birth, in particular among preterm infants treated with TPR. Full SR of the literature is advised. Impact This scoping review identified studies comparing TPR vs. SIB for respiratory support of newborn infants previously not included in the International Liaison Committee on Resuscitation (ILCOR) recommendations.Our review found substantive new evidence highlighting that device choice may impact the outcomes of compromised newborn infants'.This scoping review stipulates the need for full SR and updated meta-analysis of studies investigating supportive equipment for stabilizing infants at birth in order to inform ILCOR treatment recommendations.
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Oxygen supplementation in the delivery room: T-piece Resuscitator cap open or occluded?
Journal of Perinatology, 2019Co-Authors: Lindsay Ellsworth, Meera Meerkov, Nicoletta Doglioni, Daniele Trevisanuto, Gary WeinerAbstract:Objective Updated neonatal resuscitation guidelines for free-flow oxygen administration with a T-piece Resuscitator recommend higher gas flow and an open T-piece cap. We aimed to determine the effect of gas inflow rate and cap occlusion on oxygen delivery through a T-piece Resuscitator. Study design Using a NeoPuff™ T-piece, oxygen inflow was randomly adjusted from 4 to 10 liters per minute (LPM). Gas outflow and oxygen concentration were measured with the T-piece cap open and occluded. Data were analyzed with repeated measures 2-way ANOVA. Result Gas outflow was significantly decreased with the T-piece cap open compared with occluded at each inflow rate ( p
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oxygen supplementation in the delivery room t piece Resuscitator cap open or occluded
Journal of Perinatology, 2019Co-Authors: Lindsay Ellsworth, Meera Meerkov, Nicoletta Doglioni, Daniele Trevisanuto, Gary WeinerAbstract:OBJECTIVE Updated neonatal resuscitation guidelines for free-flow oxygen administration with a T-piece Resuscitator recommend higher gas flow and an open T-piece cap. We aimed to determine the effect of gas inflow rate and cap occlusion on oxygen delivery through a T-piece Resuscitator. STUDY DESIGN Using a NeoPuff™ T-piece, oxygen inflow was randomly adjusted from 4 to 10 liters per minute (LPM). Gas outflow and oxygen concentration were measured with the T-piece cap open and occluded. Data were analyzed with repeated measures 2-way ANOVA. RESULT Gas outflow was significantly decreased with the T-piece cap open compared with occluded at each inflow rate (p < 0.001). There was no difference in oxygen concentration of the outflow gas. CONCLUSION Gas flow from the T-piece is affected by the inflow rate and cap occlusion but oxygen concentration is not. To deliver 5 LPM of free-flow oxygen with the cap open, a minimum of 8 LPM gas inflow is required.
Peter G Davis - One of the best experts on this subject based on the ideXlab platform.
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t piece Resuscitator or self inflating bag during neonatal resuscitation a scoping review
Pediatric Research, 2020Co-Authors: Charles Christoph Roehr, Peter G Davis, Gary Weiner, Jonathan J Wyllie, Myra H Wyckoff, Daniele TrevisanutoAbstract:Background To identify the evidence for administering positive pressure ventilation (PPV) to infants at birth by either T-piece Resuscitator (TPR) or self-inflating bag (SIB), and to determine whether a full systematic review (SR) is warranted. Methods Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews, eligible studies included peer-reviewed human studies, prospectively or retrospectively comparing a TPR vs. SIB for administering PPV at birth. Databases searched were OVID Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials. Review Manager software was used for the data analysis. Results Following electronic literature search and review, data from four eligible studies (3 RCT and 1 observational study), enrolling a total of 2889 patients, were included. Studies differed regarding the investigated populations, reported outcomes and came from different geographical areas. In particular for preterm infants, use of TPR for providing PPV may improve survival, result in fewer intubations at birth and decrease the incidence of bronchopulmonary dysplasia. Conclusions This scoping review identified two new studies with substantive new evidence, pointing towards improved survival, decreased bronchopulmonary dysplasia and fewer intubations at birth, in particular among preterm infants treated with TPR. Full SR of the literature is advised. Impact This scoping review identified studies comparing TPR vs. SIB for respiratory support of newborn infants previously not included in the International Liaison Committee on Resuscitation (ILCOR) recommendations.Our review found substantive new evidence highlighting that device choice may impact the outcomes of compromised newborn infants'.This scoping review stipulates the need for full SR and updated meta-analysis of studies investigating supportive equipment for stabilizing infants at birth in order to inform ILCOR treatment recommendations.
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The accuracy of delivery of target pressures using self-inflating bag manometers in a benchtop study
Acta Paediatrica, 2016Co-Authors: Anthony R. Rafferty, Peter G Davis, Jennifer A Dawson, Lucy Johnson, Dominic A Maxfield, Marta ThioAbstract:ABSTRACTAim:We tested whether operators using manometers attached to self-inflating bags could accurately deliver set targeted peak inspiratory pressures (PIPs) compared to the Neopuff™ T-piece Resuscitator (TPR).Methods:Participants provided positive pressure ventilation to a leak-free neonatal tes
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The accuracy of delivery of target pressures using self‐inflating bag manometers in a benchtop study
Acta Paediatrica, 2016Co-Authors: Anthony R. Rafferty, Peter G Davis, Jennifer A Dawson, Lucy Johnson, Dominic A Maxfield, Marta ThioAbstract:ABSTRACTAim:We tested whether operators using manometers attached to self-inflating bags could accurately deliver set targeted peak inspiratory pressures (PIPs) compared to the Neopuff™ T-piece Resuscitator (TPR).Methods:Participants provided positive pressure ventilation to a leak-free neonatal tes
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assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room
Archives of Disease in Childhood-fetal and Neonatal Edition, 2010Co-Authors: Georg M Schmolzer, Colin J Morley, Colm P F Odonnell, Omar C O F Kamlin, Jennifer A Dawson, Peter G DavisAbstract:Aim The aim was to compare Resuscitators’ estimates of tidal volume (V T ) and face mask leak with measured values during positive pressure ventilation (PPV) of newborn infants in the delivery room. Patients and methods The authors measured infl ating pressures and V T delivered using a respiratory function monitor, and calculated face mask leak. After 60 s of PPV, Resuscitators were asked to estimate V T and face mask leak. These estimates were compared with measurements taken during the previous 30 s. Results The authors studied 20 infants who received a mean (SD) of 21 (6) infl ations during the 30 s. The median (IQR) expired tidal volume (V Te ) delivered was 8.7 ml/kg (5.3–11.3). V Te varied widely during each resuscitation and between Resuscitators. Five Resuscitators could not estimate V Te , one overestimated and 14 underestimated their median delivered V Te . The median (IQR) face mask leak was 29% (16–63%). Leak also varied widely during each resuscitation and between Resuscitators. One Resuscitator could not estimate mask leak, four overestimated leak and 15 underestimated leak. Conclusion During face mask ventilation in the delivery room, V T and face mask leak were large and variable. The Resuscitators were unable to accurately assess their face mask leak or delivered V T .
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choice of flow meter determines pressures delivered on a t piece neonatal Resuscitator
Archives of Disease in Childhood-fetal and Neonatal Edition, 2010Co-Authors: Georg M Schmolzer, Colin J Morley, Risha Bhatia, Peter G DavisAbstract:Using a Neopuff Infant Resuscitator (Fisher & Paykel Healthcare, Auckland, New Zealand), Hawkes et al 1 showed that a peak inflating pressure (PIP) >100 cm H2O can be delivered with a flow meter at maximum flow. We tested five flow meters to determine the pressures delivered at different flow rates. Gas flow was analysed using the Timeter RT-200 Flow Analyser (Timeter-Instruments, St Louis, Missouri, USA). Each flow meter was tested connected to a wall oxygen outlet or a low-flow air/oxygen blender (Cardinal Health, Ohio, USA). Positive pressure ventilation was given to a leak-free test lung using a Neopuff. Neopuff set to PIP 20 cm H2O, …
Colin J Morley - One of the best experts on this subject based on the ideXlab platform.
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assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room
Archives of Disease in Childhood-fetal and Neonatal Edition, 2010Co-Authors: Georg M Schmolzer, Colin J Morley, Colm P F Odonnell, Omar C O F Kamlin, Jennifer A Dawson, Peter G DavisAbstract:Aim The aim was to compare Resuscitators’ estimates of tidal volume (V T ) and face mask leak with measured values during positive pressure ventilation (PPV) of newborn infants in the delivery room. Patients and methods The authors measured infl ating pressures and V T delivered using a respiratory function monitor, and calculated face mask leak. After 60 s of PPV, Resuscitators were asked to estimate V T and face mask leak. These estimates were compared with measurements taken during the previous 30 s. Results The authors studied 20 infants who received a mean (SD) of 21 (6) infl ations during the 30 s. The median (IQR) expired tidal volume (V Te ) delivered was 8.7 ml/kg (5.3–11.3). V Te varied widely during each resuscitation and between Resuscitators. Five Resuscitators could not estimate V Te , one overestimated and 14 underestimated their median delivered V Te . The median (IQR) face mask leak was 29% (16–63%). Leak also varied widely during each resuscitation and between Resuscitators. One Resuscitator could not estimate mask leak, four overestimated leak and 15 underestimated leak. Conclusion During face mask ventilation in the delivery room, V T and face mask leak were large and variable. The Resuscitators were unable to accurately assess their face mask leak or delivered V T .
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choice of flow meter determines pressures delivered on a t piece neonatal Resuscitator
Archives of Disease in Childhood-fetal and Neonatal Edition, 2010Co-Authors: Georg M Schmolzer, Colin J Morley, Risha Bhatia, Peter G DavisAbstract:Using a Neopuff Infant Resuscitator (Fisher & Paykel Healthcare, Auckland, New Zealand), Hawkes et al 1 showed that a peak inflating pressure (PIP) >100 cm H2O can be delivered with a flow meter at maximum flow. We tested five flow meters to determine the pressures delivered at different flow rates. Gas flow was analysed using the Timeter RT-200 Flow Analyser (Timeter-Instruments, St Louis, Missouri, USA). Each flow meter was tested connected to a wall oxygen outlet or a low-flow air/oxygen blender (Cardinal Health, Ohio, USA). Positive pressure ventilation was given to a leak-free test lung using a Neopuff. Neopuff set to PIP 20 cm H2O, …
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free flow oxygen delivery using a t piece Resuscitator
Archives of Disease in Childhood-fetal and Neonatal Edition, 2007Co-Authors: Jennifer A Dawson, Peter G Davis, C O F Kamlin, Colin J MorleyAbstract:T-pieces are increasingly used for administering intermittent positive pressure ventilation (IPPV) during neonatal resuscitation.1 They can also be used to provide free-flowing oxygen to babies who are breathing but remain cyanosed.2 The Neonatal Resuscitation Program (NRP) guidelines recommend that when using a T-piece Resuscitator the mask should be loosely placed on the infant’s face with the positive end expiratory pressure (PEEP) valve occluded to allow delivery of a reliable amount of oxygen.2 There are no reports documenting the percentage of oxygen delivered when the PEEP valve is, or is not, occluded. …
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neonatal resuscitation 3 manometer use in a model of face mask ventilation
Archives of Disease in Childhood-fetal and Neonatal Edition, 2005Co-Authors: Colm P F Odonnell, Peter G Davis, Peter A Dargaville, Lex W. Doyle, Colin J MorleyAbstract:Background: Adequate ventilation is the key to successful neonatal resuscitation. Positive pressure ventilation (PPV) is initiated with manual ventilation devices via face masks. These devices may be used with a manometer to measure airway pressures delivered. The expiratory tidal volume measured at the mask (V TE(mask) ) is a good estimate of the tidal volume delivered during simulated neonatal resuscitation. Aim: To assess the effect of viewing a manometer on the peak inspiratory pressures used, the volume delivered, and leakage from the face mask during PPV with two manual ventilation devices in a model of neonatal resuscitation. Methods: Participants gave PPV to a modified resuscitation mannequin using a Laerdal infant Resuscitator and a Neopuff infant Resuscitator at specified pressures ensuring adequate chest wall excursion. Each participant gave PPV to the mannequin with each device twice, viewing the manometer on one occasion and unable to see the manometer on the other. Data from participants were averaged for each device used with the manometer and without the manometer separately. Results: A total of 7767 inflations delivered by the 18 participants were recorded and analysed. Peak inspiratory pressures delivered were lower with the Laerdal device. There were no differences in leakage from the face mask or volumes delivered. Whether or not the manometer was visible made no difference to any measured variable. Conclusions: Viewing a manometer during PPV in this model of neonatal resuscitation does not affect the airway pressure or tidal volumes delivered or the degree of leakage from the face mask.
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Neonatal resuscitation 2: an evaluation of manual ventilation devices and face masks
Archives of Disease in Childhood-fetal and Neonatal Edition, 2005Co-Authors: C P F O'donnell, Peter G Davis, Peter A Dargaville, Lex W. Doyle, R Lau, Colin J MorleyAbstract:Background: The key to successful neonatal resuscitation is effective ventilation. Little evidence exists to guide clinicians in their choice of manual ventilation device or face mask. The expiratory tidal volume measured at the mask (VTE(mask)) is a good estimate of the tidal volume delivered during simulated neonatal resuscitation. Aim: To compare the efficacy of (a) the Laerdal infant Resuscitator and the Neopuff infant Resuscitator, used with (b) round and anatomically shaped masks in a model of neonatal resuscitation. Methods: Thirty four participants gave positive pressure ventilation to a mannequin at specified pressures with each of the four device-mask combinations. Flow, inspiratory tidal volume at the face mask (VTI(mask)), VTE(mask), and airway pressure were recorded. Leakage from the mask was calculated from VTI(mask) and VTE(mask). Results: A total of 10 780 inflations were recorded and analysed. Peak inspiratory pressure targets were achieved equally with the Laerdal and Neopuff Resuscitators. Positive end expiratory pressure was delivered with the Neopuff but not the Laerdal device. Despite similar peak pressures, VTE(mask) varied widely. Mask leakage was large for each combination of device and mask. There were no differences between the masks. Conclusion: During face mask ventilation of a neonatal resuscitation mannequin, there are large leaks around the face mask. Airway pressure is a poor proxy for volume delivered during positive pressure ventilation through a mask.
Peter Ryser - One of the best experts on this subject based on the ideXlab platform.
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ultra low pressure sensor for neonatal Resuscitator
Sensors and Actuators A-physical, 2011Co-Authors: Caroline Jacq, Thomas Maeder, Enrico Haemmerle, Nicolas Craquelin, Peter RyserAbstract:A Venturi-type flow sensor has been designed and fabricated for neonatal respiratory assistance to control airway pressure and tidal volume. As the low flow range and sensing principle require the measurement of correspondingly very low pressures, a very responsive sensor, based on a polymer membrane acting onto a piezoresistive cantilever force sensor based on low-temperature co-fired ceramic (LTCC), was developed. This paper details the 3D modelling, manufacture, assembly and characterisation of the sensor. Compared to expensive and fragile MEMS-based devices, this sensor, based on LTCC, thick-film technology and polymer parts, provides an accurate and robust, yet low-cost alternative.
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ultra low pressure sensor for neonatal Resuscitator
Procedia Engineering, 2010Co-Authors: Caroline Jacq, Thomas Maeder, Enrico Haemmerle, Nicolas Craquelin, Peter RyserAbstract:A Venturi-type flow sensor has been designed and fabricated for neonatal respiratory assistance to control airway pressure and tidal volume. As the low flow range and sensing principle require the measurement of correspondingly very low pressures, a very responsive sensor, based on a polymer membrane acting onto a piezoresistive cantilever force sensor based on low-temperature co-fired ceramic (LTCC), was developed. This paper details the 3D modelling, manufacture, assembly and characterisation of the sensor. Compared to expensive and fragile MEMS-based devices, this sensor, based on LTCC, thick-film technology and polymer parts, provides an accurate and robust, yet low-cost alternative. Keywords: pressure sensor; Venturi flow sensor; LTCC; thick-film technology.