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; Lieve A Willemsen; Sophie J E Cramer; Aidan J Kashyap; Thomas Drevhammar; Stuart B Hooper; Arjan B Te Pas

doi:10.3389/fped.2022.817010

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

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

Authors

Kristel L A M Kuypers¹, Lieve A Willemsen¹, Sophie J E Cramer¹, Aidan J Kashyap^{2

3}, Thomas Drevhammar^{4

5}, Stuart B Hooper^{2

3}, Arjan B Te Pas¹

Affiliations

¹ Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands.
² The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
³ Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.
⁴ Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Anaesthesiology, Östersund Hospital, Östersund, Sweden.

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.