Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Basic Science Article
  • Published:

The effect of imposed resistance in neonatal resuscitators on pressure stability and peak flows: a bench test

Pediatric Research volume 94, pages 1929–1934 (2023)Cite this article

Abstract

Background

The importance of neonatal resuscitator resistance is currently unknown. In this study we investigated peak flows and pressure stability resulting from differences in imposed resistance during positive pressure ventilation(PPV) and simulated spontaneous breathing (SSB) between the r-PAP, low-resistance resuscitator, and Neopuff™, high-resistance resuscitator.

Methods

In a bench test, 20 inflations during PPV and 20 breaths during SSB were analysed on breath-by-breath basis to determine peak flow and pressure stability using the Neopuff™ with bias gas flow of 8, 12 or 15 L/min and the r-PAP with total gas flow of 15 L/min.

Results

Imposed resistance of the Neopuff™ was significantly reduced when the bias gas flow was increased from 8 to 15 L/min, which resulted in higher peak flows during PPV and SSB. Peak flows in the r-PAP were, however, significantly higher and fluctuations in CPAP during SSB were significantly smaller in the r-PAP compared to the Neopuff™ for all bias gas flow levels. During PPV, a pressure overshoot of 3.2 cmH2O was observed in the r-PAP.

Conclusions

The r-PAP seemed to have a lower resistance than the Neopuff™ even when bias gas flows were increased. This resulted in more stable CPAP pressures with higher peak flows when using the r-PAP.

Impact

  • The traditional T-piece system (Neopuff™) has a higher imposed resistance compared to a new neonatal resuscitator (r-PAP).

  • This study shows that reducing imposed resistance leads to smaller CPAP fluctuations and higher inspiratory and expiratory peak flows.

  • High peak flows might negatively affect lung function and/or cause lung injury in preterm infants at birth. This study will form the rationale for further studies investigating these effects.

  • A possible compromise might be to use the traditional T-piece system with a higher bias gas flow (12 L/min), thereby reducing the imposed resistance and generating more stable PEEP/CPAP pressures, while limiting potentially harmful peak flows.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Test-lung.
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Kuypers, K. L. A. M. et al. The effect of a higher bias gas flow on imposed T-piece resistance and breathing in preterm infants at birth. Front. Pediatr. 10, 817010 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hinder, M., McEwan, A., Drevhammer, T., Donaldson, S. & Tracy, M. B. T-piece resuscitators: how do they compare? Arch. Dis. Child Fetal Neonatal Ed. 104, F122–F7 (2019).

    Article  PubMed  Google Scholar 

  3. Drevhammar, T., Nilsson, K., Zetterström, H. & Jonsson, B. Comparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing. Pediatr. Crit. Care Med. 13, e113–e119 (2012).

    Article  PubMed  Google Scholar 

  4. Wald, M. et al. Variety of expiratory resistance between different continuous positive airway pressure devices for preterm infants. Artif. Organs 35, 22–28 (2011).

    Article  PubMed  Google Scholar 

  5. Donaldsson, S., Drevhammar, T., Taittonen, L., Klemming, S. & Jonsson, B. Initial stabilisation of preterm infants: a new resuscitation system with low imposed work of breathing for use with face mask or nasal prongs. Arch. Dis. Child. Fetal Neonatal Ed. 102, F203–F207 (2017).

    Article  PubMed  Google Scholar 

  6. Donaldsson, S. et al. Comparison of respiratory support after delivery in infants born before 28 weeks’ gestational age: The CORSAD Randomized Clinical Trial. JAMA Pediatr. 175, 911–918 (2021).

    Article  PubMed  Google Scholar 

  7. Basser, P. J., McMahon, T. A. & Griffith, P. The mechanism of mucus clearance in cough. J. Biomech. Eng. 111, 288–297 (1989).

    Article  CAS  PubMed  Google Scholar 

  8. Huckstadt, T., Foitzik, B., Wauer, R. R. & Schmalisch, G. Comparison of two different CPAP systems by tidal breathing parameters. Intensive Care Med. 29, 1134–1140 (2003).

    Article  PubMed  Google Scholar 

  9. Ferhardt, T., Reifenberg, L., Hehre, D., Feller, R. & Bancalari, E. Functional residual capacity in normal neonates and children up to 5 years of age determined by N2 washout method. Pediatr. Res. 20, 668–671 (1986).

    Article  Google Scholar 

  10. LoMauro, A. & Aliverti, A. Physiology masterclass: extremes of age: newborn and infancy. Breathe (Sheff.) 12, 65–68 (2016).

    Article  PubMed  Google Scholar 

  11. Hinder, M. K. et al. T-piece resuscitators: can they provide safe ventilation in a low compliant newborn lung? Arch. Dis. Child Fetal Neonatal. Ed. 106, 25–30 (2021).

    Article  PubMed  Google Scholar 

  12. Drevhammar, T., Berg, N., Nilsson, K., Jonsson, B. & Prahl Wittberg, L. Flows and function of the infant flow neonatal continuous positive airway pressure device investigated with computational fluid dynamics. Acta Paediatr. (Oslo, Nor. : 1992) 110, 811–817 (2021).

    Article  Google Scholar 

Download references

Funding

This work was supported by Fisher & Paykel Healthcare Limited by an unrestricted grant. Fisher & Paykel Healthcare Limited had no role in study design nor in the collection, analysis, and interpretation of data, writing of the manuscript and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Paediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Centre, Leiden, The Netherlands

    Kristel L. A. M. Kuypers, Sophie J. E. Cramer & Arjan B. te Pas

  2. The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia

    Aidan J. Kashyap & Stuart B. Hooper

  3. Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia

    Aidan J. Kashyap & Stuart B. Hooper

Authors
  1. Kristel L. A. M. Kuypers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aidan J. Kashyap
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sophie J. E. Cramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stuart B. Hooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arjan B. te Pas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

K.K.: co-conceived the study, conducted the study, collected, analysed and interpreted the data, wrote the first draft of the manuscript and approved the final version of the manuscript. A.K.: co-conceived the study, conducted the study, collected and interpreted the data, reviewed and edited the manuscript and approved the final version of the manuscript. S.C.: data interpretation, reviewed and edited the manuscript and approved the final version of the manuscript. S.H.: co-conceived the study, supervised the study, interpreted the data, reviewed and edited the manuscript and approved the final version. A.B.t.P.: co-conceived the study, supervised the study, interpreted the data, reviewed and edited the first draft of the manuscript and approved the final version. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Kristel L. A. M. Kuypers.

Ethics declarations

Competing interests

K.L.A.M. Kuypers is the recipient of an unrestricted research grant from Fisher & Paykel Healthcare Limited; they had no role in study design nor in the collection, analysis, and interpretation of data, writing of the report and decision to submit the paper for publication.

Ethics approval and consent to participate

Patient consent was not required for this study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuypers, K.L.A.M., Kashyap, A.J., Cramer, S.J.E. et al. The effect of imposed resistance in neonatal resuscitators on pressure stability and peak flows: a bench test. Pediatr Res 94, 1929–1934 (2023). https://doi.org/10.1038/s41390-023-02715-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-023-02715-x

Search

Advanced search

Quick links