Potential hazard of the Neopuff T-piece resuscitator in the absence of flow limitation.
- Colin P Hawkes (cphawkes{at}gmail.com)
- Oluwole A Oni (wolexza{at}yahoo.com)
- Eugene M Dempsey (gene.dempsey{at}mailp.hse.ie)
Abstract
Objective: To assess (i) Peak Inspiratory Pressure (PIP), Positive End Expiratory Pressure (PEEP) and maximum pressure relief (Pmax) at different rates of gas flow, when the Neopuff had been set to function at 5L/min. (ii) To assess maximum PIP and PEEP at a flow rate of 10L/min with a simulated air leak of 50%.
Design: 5 Neopuffs were set to a PIP of 20, PEEP of 5 and Pmax of 30 cm H2O at a gas flow of 5L/min. PIP, PEEP and Pmax were recorded at flow rates of 10, 15L/min and maximum flow. Maximum achievable pressures at 10L/min gas flow, with a 50% air leak, were measured.
Results: At gas flow of 15L/min, mean PEEP increased to 20 (95% CI 20-21), PIP to 28 (95% CI 28-29) and the Pmax to 40 cm H2O (95% CI 38-42). At maximum flow (85L/min) a PEEP of 79 (95% CI 51-91) and PIP of 103 cm H2O (95% CI 69-115) were generated. At 10L/min flow, with an air leak of 50%, the maximum PEEP and PIP were 21 (95% CI 19-23) and 69 cm H2O (95% CI 66-71).
Conclusions: The maximum pressure relief valve is overidden by increasing the rate of gas flow and potentially harmful PIP and PEEP can be generated. Even in the presence of a 50% gas leak, more than adequate pressures can be provided at 10L/min gas flow. We recommend the limitation of gas flow to a rate of 10L/min as an added safety mechanism for this device.
