What initial peak inspiratory pressure (PIP) should be set for resuscitation?

The initial peak inspiratory pressure (PIP) of 20-25 cm H2O is recommended for neonatal resuscitation because it provides an effective balance between ensuring adequate ventilation and minimizing the risk of barotrauma (lung injury) in the delicate lungs of newborns. In this pressure range, it is sufficient to open collapsed alveoli (atelectatic lung units) and allow for effective gas exchange without over-distending the lungs, which can lead to complications such as pneumothoraces or ventilatory-induced lung injury.

Setting the PIP too low may result in inadequate ventilation, hindering the removal of carbon dioxide and the provision of oxygen. Conversely, setting it too high can risk damaging the fragile structures of an infant's lungs. Therefore, maintaining the PIP within this optimal range is critical during the initial phase of resuscitation to achieve the best outcomes while promoting lung health.