Safety of modified T-piece resuscitator versus nasal cannula oxygen in electronic bronchoscopy for infants: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To optimize the oxygen therapy regimens for infants with pulmonary diseases during bronchoscopy.@*METHODS@#A prospective randomized, controlled, and single-center clinical trial was conducted on 42 infants who underwent electronic bronchoscopy from July 2019 to July 2021. These infants were divided into a nasal cannula (NC) group and a modified T-piece resuscitator (TPR) group using a random number table. The lowest intraoperative blood oxygen saturation was recorded as the primary outcome, and intraoperative heart rate and respiratory results were recorded as the secondary outcomes.@*RESULTS@#Compared with the NC group, the modified TPR group had a significantly higher level of minimum oxygen saturation during surgery and a significantly lower incidence rate of hypoxemia (P<0.05). In the modified TPR group, there were 6 infants with mild hypoxemia, 2 with moderate hypoxemia, and 1 with severe hypoxemia, while in the NC group, there were 3 infants with mild hypoxemia, 5 with moderate hypoxemia, and 9 with severe hypoxemia (P<0.05). The modified TPR group had a significantly lower incidence rate of intraoperative respiratory rhythm abnormalities than the NC group (P<0.05), but there was no significant difference in the incidence rate of arrhythmias between the two groups (P>0.05).@*CONCLUSIONS@#Modified TPR can significantly reduce the risk of hypoxemia in infants with pulmonary diseases during electronic bronchoscopy, and TPR significantly decreases the severity of hypoxemia and the incidence of respiratory rhythm abnormalities compared with traditional NC.

Does T-piece resuscitator in the delivery room improve the resuscitation efficacy on very preterm infants / 中国新生儿科杂志

Objective To study the efficacy of T-piece resuscitator on the very preterm infants in the delivery room.Method Very preterm infants (gestational age 28 ～ 31 weeks) who needed positive pressure ventilation during delivery room resuscitation were included in the study between January 2010 and December 2015.Enrolled infants were randomly assigned to self-inflating bag group and T-piece group.Tracheal intubation ratio,duration of mechanical ventilation,continuous positive airway pressure (CPAP),supplementary oxygen through a nasal cannula and total oxygen requirement were compared between groups.The percentages of pneumothorax,sepsis,necrotizing enterocolitis (NEC),bronchopulmonary dysplasia (BPD),retinopathy of prematurity (ROP),intracranial hemorrhage and patent ductus arteriosus (PDA) between groups were also compared.Data were analyzed using independent sample t test and chi-square test.Result A total of 51 preterm infants were enrolled in this study,with 25 infants in the self-inflating bag group and 26 in the T-piece group.There was no statistically significant difference in the gender,gestational age,birth weight,Apgar scores,delivery mode and antenatal glucocorticoids between the two groups (P ＞ 0.05).The ratio of intubation in T-piece group was significantly lower than that in self-inflating bag group (15.4％ vs.44.0％,P ＜ 0.05).Further more,duration of mechanical ventilation and total oxygen requirement in the T-piece group were significantly shorter than those in the self-inflating bag group [(4.2±2.8) dvs.(10.1 ±4.3) d,(36.2±14.7) dvs.(47.2±19.2) d,P＜0.05].However,the duration of nasal CPAP and supplementary oxygen through a nasal cannula,the rate of pneumothorax,sepsis,NEC,BPD,ROP,intracranial hemorrhage and PDA did not differ significantly between groups (P ＞ 0.05).Conclusion Compared with the self-inflating bag group,the use of the T-piece in delivery room decrease the rate of tracheal intubation and the duration of mechanical ventilation and total oxygen requirement.

Reduction of intubation rate during newborn resuscitationafter transition from self-inflating bag to T-piece resuscitator: A quality improvement project

Introduction: T-piece resuscitator (TPR) has many advantages compared to self-inflating bag (SIB). Early Continuous Positive Airway Pressure (CPAP) during newborn resuscitation (NR) with TPR at delivery can reduce intubation rate. Methods: We speculated that the intubation rate at delivery room was high because SIB had always been used during NR and this can be improved with TPR. Intubation rate of newborn 50%. An audit was carried out in June 2010 to verify this problem using a check sheet. Results: 25 neonates without major congenital anomalies who required NR with SIB at delivery were included. Intubation rate of babies <24 hours of life when SIB was used was 68%. Post-intervention audit (August to November 2010) on 25 newborns showed that the intubation rate within 24 hours dropped to 8% when TPR was used. Proportion of intubated babies reduced from 48.3% (2008-2009) to 35.1% (2011-2012), odds ratio 0.58 (95% CI 0.49-0.68). Proportion of neonates on CPAP increased from 63.5% (2008-2009) to 81.0% (2011-2012), odds ratio 2.44 (95% CI 2.03-2.93). Mean ventilation days fell to below 4 days after 2010. Since then, all delivery standbys were accompanied by TPR and it was used for all NR regardless of settings. There was decline in intubation rate secondary to early provision of CPAP with TPR during NR. Mean ventilation days, mortality and length of NICU stay were reduced. Conclusion: This practice should be adopted by all hospitals in the country to achieve Millennium Development Goal 4 (2/3 decline of under 5 mortality rate) by 2015.