TY - JOUR
T1 - Optimizing bag-valve-mask ventilation with a new mouth-to-bag resuscitator
AU - Wagner-Berger, Horst G.
AU - Wenzel, Volker
AU - Stallinger, Angelika
AU - Voelckel, Wolfgang G.
AU - Rheinberger, Klaus
AU - Augenstein, Sven
AU - Herff, Holger
AU - Idris, Ahamed H.
AU - Dörges, Volker
AU - Lindner, Karl H.
AU - Hörmann, Christoph
N1 - Funding Information:
The authors wish to thank Mrs Faschinelli for her advice and support throughout the study. Further, we would like to thank the nurse volunteers of the Leopold-Franzens-University Hospital, Innsbruck, Austria, who donated their time and effort to make this study possible. We are indebted to Ole Køhnke for his technical advice and assistance. This project was supported, in part, by the Austrian Science Foundation Grant P14169-MED, Vienna, Austria; Ambu International A/S, Glostrup, Denmark and the Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria. No author has a conflict of interest in regard to ventilation devices discussed in this manuscript.
PY - 2003/2/1
Y1 - 2003/2/1
N2 - When ventilating an unintubated patient with a self-inflating bag, high peak inspiratory flow rates may result in high peak airway pressure with subsequent stomach inflation; this may occur frequently when rescuers without daily experience in bag-valve-mask ventilation need to perform advanced airway management. The purpose of this study was to assess the effects of a newly developed self-inflating bag (mouth-to-bag resuscitator; Ambu, Glostrup, Denmark) that limits peak inspiratory flow. A bench model simulating a patient with an unintubated airway was used, consisting of a face mask, manikin head, training lung (lung compliance, 100 ml/0.098 kPa (100 ml/cm H2O)); airway resistance, 0.39 kPa/l per second (4 cm H2O/l/s), oesophagus (LESP, 1.96 kPa (20 cm H2O)) and simulated stomach. Twenty nurses were randomised to ventilate the manikin for 1 min (respiratory rate: 12 per minute) with either a standard self-inflating bag or the mouth-to-bag resuscitator, which requires the rescuer to blow up a single-use balloon inside the self-inflating bag, which in turns displaces air towards the patient. When supplemental oxygen is added, ventilation with up to 100% oxygen may be obtained, since expired air is only used as the driving gas. The mouth-to-bag resuscitator therefore allows two instead of one hand sealing the mask on the patient's face. The volunteers were blinded to the experimental design of the model until completion of the experimental protocol. The mouth-to-bag resuscitator versus standard self-inflating bag resulted in significantly (P<0.05) higher mean±S.D. mask tidal volumes (1048±161 vs. 785±174 ml) and lung tidal volumes (911±148 vs. 678±157 ml), longer inspiratory times (1.7±0.4 vs. 1.4±0.4 s), but significantly lower peak inspiratory flow rates (50±9 vs. 62±13 l/min) and mask leakage (10±4 vs. 15±9%); peak inspiratory pressure (17±2 vs. 17±2 cm H2O) and stomach tidal volumes (16±30 vs. 18±35 ml) were comparable. In conclusion, employing the mouth-to-bag resuscitator during simulated ventilation of an unintubated patient in respiratory arrest significantly decreased inspiratory flow rate and improved lung tidal volumes, while decreasing mask leakage.
AB - When ventilating an unintubated patient with a self-inflating bag, high peak inspiratory flow rates may result in high peak airway pressure with subsequent stomach inflation; this may occur frequently when rescuers without daily experience in bag-valve-mask ventilation need to perform advanced airway management. The purpose of this study was to assess the effects of a newly developed self-inflating bag (mouth-to-bag resuscitator; Ambu, Glostrup, Denmark) that limits peak inspiratory flow. A bench model simulating a patient with an unintubated airway was used, consisting of a face mask, manikin head, training lung (lung compliance, 100 ml/0.098 kPa (100 ml/cm H2O)); airway resistance, 0.39 kPa/l per second (4 cm H2O/l/s), oesophagus (LESP, 1.96 kPa (20 cm H2O)) and simulated stomach. Twenty nurses were randomised to ventilate the manikin for 1 min (respiratory rate: 12 per minute) with either a standard self-inflating bag or the mouth-to-bag resuscitator, which requires the rescuer to blow up a single-use balloon inside the self-inflating bag, which in turns displaces air towards the patient. When supplemental oxygen is added, ventilation with up to 100% oxygen may be obtained, since expired air is only used as the driving gas. The mouth-to-bag resuscitator therefore allows two instead of one hand sealing the mask on the patient's face. The volunteers were blinded to the experimental design of the model until completion of the experimental protocol. The mouth-to-bag resuscitator versus standard self-inflating bag resulted in significantly (P<0.05) higher mean±S.D. mask tidal volumes (1048±161 vs. 785±174 ml) and lung tidal volumes (911±148 vs. 678±157 ml), longer inspiratory times (1.7±0.4 vs. 1.4±0.4 s), but significantly lower peak inspiratory flow rates (50±9 vs. 62±13 l/min) and mask leakage (10±4 vs. 15±9%); peak inspiratory pressure (17±2 vs. 17±2 cm H2O) and stomach tidal volumes (16±30 vs. 18±35 ml) were comparable. In conclusion, employing the mouth-to-bag resuscitator during simulated ventilation of an unintubated patient in respiratory arrest significantly decreased inspiratory flow rate and improved lung tidal volumes, while decreasing mask leakage.
KW - Bag-valve ventilation
KW - Basic life support
KW - Lung ventilation
KW - Mouth-to-bag resuscitator
KW - Respiration-artificial
KW - Stomach inflation
KW - Unprotected airway
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U2 - 10.1016/S0300-9572(02)00347-7
DO - 10.1016/S0300-9572(02)00347-7
M3 - Article
C2 - 12589994
AN - SCOPUS:12244298894
SN - 0300-9572
VL - 56
SP - 191
EP - 198
JO - Resuscitation
JF - Resuscitation
IS - 2
ER -