AUTHOR=Kuypers Kristel L. A. M. , Willemsen Lieve A. , Cramer Sophie J. E. , Kashyap Aidan J. , Drevhammar Thomas , Hooper Stuart B. , te Pas Arjan B. 

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

JOURNAL=Frontiers in Pediatrics

VOLUME=10

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.817010

DOI=10.3389/fped.2022.817010

ISSN=2296-2360

ABSTRACT=<sec><title>Objective</title><p>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.</p></sec><sec><title>Methods</title><p>In a retrospective pre-post implementation study of preterm infants &lt;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.</p></sec><sec><title>Results</title><p>In total, 54 infants were included (bias gas flow 12 L/min: <italic>n</italic> = 27, 8 L/min: <italic>n</italic> = 27) with a median GA of 29<sup>+6</sup> (28<sup>+4</sup>–30<sup>+3</sup>) and 28<sup>+5</sup> (25<sup>+6</sup>–30<sup>+3</sup>), respectively (<italic>p</italic> = 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 H<sub>2</sub>O/L/s, <italic>p</italic> &lt; 0.001; Re: 32.0 (30.0–35.1) vs. 48.0 (46.3–53.9) cm H<sub>2</sub>O/L/s, <italic>p</italic> &lt; 0.001], while the incidence of EBM [77% (53–88) vs. 77% (58–90), <italic>p</italic> = 0.586] was similar.</p></sec><sec><title>Conclusion</title><p>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.</p></sec>