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. 2022 Mar 17:10:817010.
doi: 10.3389/fped.2022.817010. eCollection 2022.

The Effect of a Higher Bias Gas Flow on Imposed T-Piece Resistance and Breathing in Preterm Infants at Birth

Kristel L A M Kuypers  1 , Lieve A Willemsen  1 , Sophie J E Cramer  1 , Aidan J Kashyap  2   3 , Thomas Drevhammar  4   5 , Stuart B Hooper  2   3 , Arjan B Te Pas  1
Affiliations

The Effect of a Higher Bias Gas Flow on Imposed T-Piece Resistance and Breathing in Preterm Infants at Birth

Kristel L A M Kuypers et al. Front Pediatr. .

Abstract

Objective: The resistance created by the PEEP-valve of a T-piece resuscitator is bias gas flow dependent and might affect breathing in preterm infants. In this study we investigated the effect of a higher bias gas flow on the imposed inspiratory and expiratory T-piece resistance and expiratory breaking manoeuvres (EBM) in preterm infants during spontaneous breathing on CPAP at birth.

Methods: In a retrospective pre-post implementation study of preterm infants <32 weeks gestation, who were stabilised with a T-piece resuscitator, a bias gas flow of 12 L/min was compared to 8 L/min. All spontaneous breaths on CPAP within the first 10 min of starting respiratory support were analysed on a breath-by-breath basis to determine the breathing pattern of each breath and to calculate the imposed inspiratory and expiratory T-piece resistance (Ri, Re), flow rates and tidal volume.

Results: In total, 54 infants were included (bias gas flow 12 L/min: n = 27, 8 L/min: n = 27) with a median GA of 29+6 (28+4-30+3) and 28+5 (25+6-30+3), respectively (p = 0.182). Ri and Re were significantly lower in the 12 L/min compared to 8 L/min bias flow group [Ri: 29.6 (26.1-33.6) vs. 46.4 (43.0-54.1) cm H2O/L/s, p < 0.001; Re: 32.0 (30.0-35.1) vs. 48.0 (46.3-53.9) cm H2O/L/s, p < 0.001], while the incidence of EBM [77% (53-88) vs. 77% (58-90), p = 0.586] was similar.

Conclusion: During stabilisation of preterm infants at birth with a T-piece resuscitator, the use of a higher bias gas flow reduced both the imposed inspiratory and expiratory T-piece resistance for the infant, but this did not influence the incidence of EBMs.

Keywords: T-piece; bias gas flow; breathing; continuous positive airway pressure; imposed resistance; neonatal resuscitation; preterm infants; valve resistance.

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Conflict of interest statement

KK is the recipient of an unrestricted research grant from Fisher & Paykel Healthcare Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer GL declared past co-authorships with the authors AP, KK and the absence of any ongoing collaboration with any of the authors to the handling editor.

Figures

FIGURE 1
FIGURE 1
Schematic visualisation of flows, pressures, and resistance during spontaneous breathing.
FIGURE 2
FIGURE 2
Imposed inspiratory and expiratory resistance of the T-piece during spontaneous breathing on CPAP. The median (IQR) resistance (y-axis) for inspiration and expiration of both groups (x-axis) are presented in this boxplot. *p < 0.001.
See this image and copyright information in PMC

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