Use of Low-Flow Flowmeter to Titrate the FiO2 Delivered in Neonatal Resuscitation

Introduction: The oxygen concentration used in neonatal resuscitation has been a matter of debate with higher oxygen concentrations posing many adverse outcomes. Recent guidelines recommend use of blender to titrate FiO2 delivered during resuscitation. However, blender being unaffordable and unavailable at many peripheral institutions, we tried to use a low-flow flowmeter to titrate the oxygen and measure FiO2 delivered at different flow rates. Methods: From a central oxygen supply, oxygen flow was titrated using a low-flow flowmeter which was connected to a self-inflating bag and oximeter. Three variables were taken—volume of self-inflating bag, flow rate, and number of compressions per minute. FiO2 delivered with each variable, keeping the other two constant, was recorded. Results: The data obtained was analyzed by fitting the study variables into a stepwise multiple linear regression model and a linear equation was obtained. The model R square obtained suggested strong linear relationship between flow rate and FiO2 delivered. The model showed statistically significant association between flow rate and FiO2 delivery, whereas association with other variables was statistically insignificant. Discussion: Our study suggests that 76.57% of change in FiO2 is determined by change in flow rate. The major advantage of this study would be at resource poor settings where a low-flow flowmeter which is more cost effective can be used to titrate the FiO2 delivered during neonatal resuscitation.