Ambu bags is old conceptIt's hard to change old habits, but new studies show that  it's time to get rid of neonatal Ambu
bags.  While, as a matter of fact we still need Ambu-bags, we also need  to shift over to more baby friendly interfaces.

When I first got to work with Neo-puff 
in our unit I thought it wont work as I
was more comfortable with bag for
resuscitation including the labour room resuscitation. "Why can't we just bag?" i thought in my mind. However, that was before i learned how easy this machine is, and before
T Piece Resuscitator or Neopuff
i read the latest studies.

Neo-puff is a brand name, so most books refer to them as t-piece resuscitators. Its manually
operated gas powered resuscitator to provide controlled breaths unlike AMBU bag.

At the bottom you can see the inlet for gas 
where we attach O2 source (LEFT). On right is gas exit where a corrugated tube is attached. This tube is attached to a T Piece at patients end.This T piece
is  attached to either mask or Endotracheal tube as per situation just like AMBU bag. Above this, are two knobs, on left for setting PIP and on right for setting pressure for pop up valve. On the top is a pressure manometer for monitoring pressures. 

giving peep with T Piece Resuscitator  
So how do we do it, as you can see there is a white Knob and the opening in middle of T piece end, this is called as PEEP valve.

The white circular knob is moved in clockwise or
anticlockwise direction to set PEEP which can be seen in monitor

how to give breath with neopuffAll you have to do to ventilate the baby is to use
your thumb to block the PEEP valve. There is no
exhaustion at all! Even if a ventilator is not available
for brief time, we can continue with NEOPUFF.
Besides it can be carried to labour room for

Greatest advantage is not for care giver but for patient. With AMBU bag the pressures are 
never controlled plus you cannot provide PEEP, 
NEOPUFF on other hand gives constant gentle 
pressure which is much friendly with neonates fragile
lung specially preterms.

Evidence shows that inconsistent pressures from the Ambu-bag actually cause bruising in the neonate airway, and this can result in further complications for the newborn, making them extremely difficult to treat.

We in our unit started following the evidence..have you?

Dr Ajay Agade is a pediatric critical care fellow pursuing FNB  from Kanchi Kamakoti Child Trust Hospital,  passionate about free online medical education, acute care and patient safety. He is editor of dnbpediatrics and criticalpediatrics blogs |  View Ajay Agade’s  posts
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