Comparison of Tidal Volume Delivery During T-Piece Pediatric Resuscitation at Different Flows: A Bench Study

Background:

A Reusa-Tee T-piece Resuscitator (Mercury Medical, Clearwater, FL) provides consistent pressure and tidal volume for pediatric to adult patients when applied at suggested respiratory rates, I:E ratio and flow. Tidal volumes at flows of 5 L/min, and 17 L/min have been validated in previous studies.1 The purpose of this study is to determine the precision of measured tidal volumes delivered at clinician selected and frequently-used flows.

Methods:

A Reusa-Tee Pediatric T-piece resuscitator circuit was attached to a BC Biomedical LS-20001 Infant Lung Simulator with set lung compliance of 3 mL/cm/H₂O and 5 mL/cm/H₂O. Using a PEEP of +5, frequency of 20 breaths/min, I:E 1:2 and PIPs of 20, 25, and 30 and flows of 10 L/min and 15 L/min, tidal volumes were recorded from a pediatric-adult flow sensor attached to a NICO monitor (Respironics, Wallingford, CT). Values were recorded every two min at each setting. Mean values and standard deviations for each flow and pressure are displayed in the table below. Data were analyzed using the student's t-test with a clinical significance set at P<0.01. Variances in rate of tidal volume change was determined between pressures and the two flows.

Results:

There was a statistically significant difference and greater variability in delivered tidal volume change as pressure and flows were increased. Accuracy and precision in tidal volume delivery can be achieved at 10 L/min and 20 and 25 cm H₂O pressure at both compliances. There is increased variability at higher flows and pressures at higher compliance.

Conclusions:

The pediatric T-piece resuscitator delivers precise tidal volumes at lower pressures and compliances. A clinical study is necessary to validate this and determine the impact on patient outcomes.

1. Weagraff, CE, Deakins K. Evaluation of the Accuracy for Tidal Volume PIP and PEEP using a novel t-piece resuscitator for pediatric and adult patients. Respir Care 2017;62(10):suppl.

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