Thomas Drevhammer

Incomplete exhalation during resuscitation – theoretical review and examples from ventilation of newborn term infants

T-piece resuscitator systems are commonly used to provide positive pressure ventilation for non-breathing newborns in high-resource settings and can additionally provide positive end-expiratory pressure (PEEP). Short expiratory time, high resistance, rapid dynamic changes in lung compliance and large tidal volumes increase the possibility of incomplete exhalation. Our aim was to study examples of incomplete exhalations in newborn resuscitation at Stavanger University Hospital. Ventilation flow and pressure data from 129 term newborns were studied. Examples of incomplete exhalation with higher-than-set PEEP-levels were present in the recordings with visual correlation to factors affecting time needed to complete exhalation. We documented examples of incomplete exhalations with increased PEEP-levels during resuscitation of term newborns, and conclude that incomplete exhalations should be further explored, as the clinical benefit or risk of harm are not known.