Time to achieve desired fraction of inspired oxygen using a T-piece ventilator during resuscitation of preterm infants at birth

J. Dekker, F. J. Stenning, L. J.F.B. Willms, T. Martherus, S. B. Hooper, A. B. te Pas

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6 Citations (Scopus)

Abstract

Aim: To determine the time between adjustment of FiO 2 at the oxygen blender and the desired FiO 2 reaching the preterm infant during respiratory support at birth. Methods: This observational study was performed using a Neopuff T-piece Resuscitator attached to either a test lung (during initial bench tests) or a face mask during the stabilization of infants at birth. FiO 2 was titrated following resuscitation guidelines. The duration for the desired FiO 2 to reach either the test lung or face mask was recorded, both with and without leakage. A respiratory function monitor was used to record FiO 2 and amount of leak. Results: In bench tests, the median (IQR) time taken to achieve a desired FiO 2 was 34.2 (21.8–69.1) s. This duration was positively associated with the desired FiO 2 difference, the direction of titration (upwards) and the occurrence of no leak (R 2 0.863, F 65.016, p < 0.001). During stabilization of infants (median (IQR) gestational age 29 +0 (28 +2 –30 +0 ) weeks, birthweight 1290 (1240–1488) g), the duration (19.0 (0.0–57.0) s) required to reach a desired FiO 2 was less, but still evident. In 27/55 (49%) titrations, the desired FiO 2 was not achieved before the FiO 2 levels were again changed. Conclusion: There is a clear delay before a desired FiO 2 is achieved at the distal end of the T-piece resuscitator. This delay is clinically relevant as this delay could easily lead to over- and under titration of oxygen, which might result in an increased risk for both hypoxia and hyperoxia.

Original languageEnglish
Pages (from-to)100-104
Number of pages5
JournalResuscitation
Volume136
DOIs
Publication statusPublished - 1 Mar 2019
Externally publishedYes

Keywords

  • FiO titration
  • Preterm infant
  • Respiratory support
  • Resuscitation

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