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Abstract
Objective
The use of noninvasive ventilation (NIV) for newborns requiring respiratory support in delivery room (DR) is recommended. However, the details related to such use are not well established. A bench investigation on the performance of available NIV equipment was conducted.
Methods
Two T-piece resuscitators (TPRs) and three ventilators were tested with a Neonatal Lung Simulator which is capable of recording the pressure, flow, and volume. We measured the pressurization and delivered volume (DV) of nasal continuous positive airway pressure (nCPAP), bubble CPAP (bCPAP)/nasal high-frequency ventilation (nHFV), and synchronized nasal intermittent positive pressure ventilation (SNIPPV) in apneic and breathing models. Temperature and absolute humidity (AH) at the Y-piece were checked for 10 minutes in each setting while the Y-piece on an open bassinet or in a preheated incubator.
Results
The pressurization was well achieved with every combination except for TPRs on nCPAP. DV was well provided using bCPAP/nHFV and SNIPPV in the breathing model. With bCPAP, DV decreased significantly in apneic model. On the bassinet, temperature and AH dropped to ambient temperature and approximately 25 mgH2 O/L within 4 minutes, respectively. In the incubator, temperature and AH on all pre-humidified machines were maintained above 34°C and 30 mgH2 O/L for 5 minutes, respectively. Those without pre-humidification were below 30°C and less than 20 mgH2 O/L, respectively.
References
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Fig. 1.
Schematic representation of the experimental equipment and circuits/interface(s). (A) Two T-piece resuscitators (NeoPuff TM [Fisher & Paykel Healthcare Ltd., Auckland, New Zealand] and NeoPIPTM [NeoForce Group Inc., Redwood City, CA, USA]) were connected to interface A via the non-humidified circuits. (B) The bubble CPAP (F&P bubble CPAP system [Fisher & Paykel Healthcare Ltd.]) was connected to interface B and C via a humidifier. (C) The flow-driven positive pressure equipment (medinCNO® [Medin Medical Innovations Gmbh, Munchen, Deutschland]) was connected to interface D. (D) The mechanical ventilator (Sophie® [Fritz Stephan Gmbh Medizintechnik, Gackenbach, Deutschland]) was connected to interface A and B. Interface A, Easyflow nCPAP® nasal cannula (Fritz Stephan Gmbh Medizintechnik); Interface B, Miniflow® generator and prong (Medin Medical Innovations Gmbh); Interface C, FlexiTrunkTM midline interface and nasal cannula (Fisher & Paykel Healthcare Ltd.); Interface D, Medijet® generator and prongs (Medin Medical Innovations Gmbh); CPAP, continuous positive airway pressure.
Fig. 2.
The waveforms of mean airway pressure (gray), airflow (dark gray) and delivered tidal volume (black) recorded by a lung simulator during non-breathing in the F&P bubble CPAP system (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand). The pressure was set at 7 cm, and the flow was set at 7 liter/min. The pressure waveform of bCPAP showed intermittent increased pressure which was thought to be aroused by the water movement in the exhalation limb of the circuit. The waveform exhibited approximately 8 Hz frequency waves. MAP, mean airway pressure; TV, tidal volume; bCPAP, bubble continuous positive airway pressure.
Fig. 3.
Time course of changes in temperature and absolute humidity. (A) On the open bassinet, the temperature dropped below 30°C, and the humidity dropped to about 25 mgH2 O/L in about 4 minutes in every mode of preheated equipment. (B) In the incubator, the temperature and absolute humidity were maintained for about 5 minutes and gradually dropped. In the NeoPuffTM (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand) and non-heated/non-humidified Sophie® (Fritz Stephan Gmbh Medizintechnik, Gackenbach, Deutschland), the temperature remained around 30°C and the humidity also decreased, even though the proximal sensor was kept inside the incubator. CPAP, continuous positive airway pressure; nHFV, nasal high-frequency ventilation; HC, humidity compensation; SNIPPV, synchronized nasal intermittent positive pressure ventilation; NH, non-heated & non-humidified.
Table 1.
General Characteristics of Equipment/Devices Combinations
Abbreviations: A, Easyflow nCPAP ® nasal cannula (Fritz Stephan Gmbh Medizintechnik, Gackenbach, Deutschland); B, Miniflow ® generator and prongs (Medin Medical Innovations Gmbh, Munchen, Deutschland); C, FlexiTrunkTM midline interface and nasal cannula (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand); D, Medijet ® generator and prongs (Medin Medical Innovations Gmbh).
Table 2.
Measured Pressure and Delivered Volume in Nasal Continuous Positive Airway Pressure Mode
Abbreviations: SD, standard deviation; Pmean, mean pressure; A, Easyflow nCPAP® nasal cannula (Fritz Stephan Gmbh Medizintechnik, Gackenbach, Deutschland); B, Miniflow® generator and prongs (Medin Medical Innovations Gmbh, Munchen, Deutschland); D, Medijet® generator and prongs (Medin Medical Innovations Gmbh).*Fisher & Paykel Healthcare Ltd., Auckland, New Zealand.
Table 3.
Measured Pressure and Delivered Volume in Bubble Continuous Positive Airway Pressure/Nasal High Frequency Ventilation Mode
Abbreviations: Pmax, maximum pressure; Pmin, minimum pressure; Pmean, mean pressure; SD, standard deviations; B, Miniflow ® generator and prongs (Medin Medical Innovations Gmbh, Munchen, Deutschland); C, FlexiTrunkTM midline interface and nasal cannula (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand); D, Medijet® generator and prongs (Medin Medical Innovations Gmbh); A, Easyflow nCPAP® nasal cannula (Fritz Stephan Gmbh Medizintechnik, Gackenbach, Deutschland).
Table 4.
Measured Pressure and Delivered Volume in Synchronized Nasal Intermittent Positive Pressure Ventilation Mode
| Equipment | Interface | O2 flow (L/min) | Pressure (cmH2 O) | Simulated self-respiration | Measured Pmax (cmH2 O) | Measured Pmin (cmH2 O) | Measured Pmean±SD (cmH2O) | Delivered volume±SD (mL) |
|---|---|---|---|---|---|---|---|---|
| medinCNO ®* | D | 7+4 | No | 11.6 | 5.02 | 6.43±1.88 | 1.74±0.75 | |
| Yes | 11.8 | 5.14 | 6.83±2.10 | 2.28±0.42 | ||||
| Sophie®† | A | 15+5 | No | 14.6 | 4.49 | 7.75±4.07 | 4.28±0.05 | |
| Yes | 15.2 | 4.46 | 8.69±4.25 | 4.43±0.37 | ||||
| B | 15+5 | No | 14.6 | 4.51 | 7.57±3.68 | 4.11±0.07 | ||
| Yes | 16.1 | 4.59 | 8.28±3.88 | 4.33±0.34 |
Abbreviations: Pmax, maximum pressure; Pmin, minimum pressure; Pmean, mean pressure; SD, standard deviations; D, Medijet® generator and prongs (Medin Medical Innovations Gmbh, Munchen, Deutschland); A, Easyflow nCPAP® nasal cannula (Fritz Stephan Gmbh Medizintechnik, Gackenbach, Deutschland); B, Miniflow® generator and prongs (Medin Medical Innovations Gmbh).
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