Dataset Information

Comparison of bag-valve-mask hand-sealing techniques in a simulated model.

ABSTRACT: Bag-valve-mask ventilation remains an essential component of airway management. Rescuers continue to use both traditional 1- or 2-handed mask-face sealing techniques, as well as a newer modified 2-handed technique. We compare the efficacy of 1-handed, 2-handed, and modified 2-handed bag-valve-mask technique.In this prospective, crossover study, health care providers performed 1-handed, 2-handed, and modified 2-handed bag-valve-mask ventilation on a standardized ventilation model. Subjects performed each technique for 5 minutes, with 3 minutes' rest between techniques. The primary outcome was expired tidal volume, defined as percentage of total possible expired tidal volume during a 5-minute bout. A specialized inline monitor measured expired tidal volume. We compared 2-handed versus modified 2-handed and 2-handed versus 1-handed techniques.We enrolled 52 subjects: 28 (54%) men, 32 (62%) with greater than or equal to 5 actual emergency bag-valve-mask situations. Median expired tidal volume percentage for 1-handed technique was 31% (95% confidence interval [CI] 17% to 51%); for 2-handed technique, 85% (95% CI 78% to 91%); and for modified 2-handed technique, 85% (95% CI 82% to 90%). Both 2-handed (median difference 47%; 95% CI 34% to 62%) and modified 2-handed technique (median difference 56%; 95% CI 29% to 65%) resulted in significantly higher median expired tidal volume percentages compared with 1-handed technique. The median expired tidal volume percentages between 2-handed and modified 2-handed techniques did not significantly differ from each other (median difference 0; 95% CI -2% to 2%).In a simulated model, both 2-handed mask-face sealing techniques resulted in higher ventilatory tidal volumes than 1-handed technique. Tidal volumes from 2-handed and modified 2-handed techniques did not differ. Rescuers should perform bag-valve-mask ventilation with 2-handed techniques.

SUBMITTER: Otten D

PROVIDER: S-EPMC4866830 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Comparison of bag-valve-mask hand-sealing techniques in a simulated model.

Otten David D Liao Michael M MM Wolken Robert R Douglas Ivor S IS Mishra Ramya R Kao Amanda A Barrett Whitney W Drasler Erin E Byyny Richard L RL Haukoos Jason S JS

Annals of emergency medicine 20130809 1

<h4>Study objective</h4>Bag-valve-mask ventilation remains an essential component of airway management. Rescuers continue to use both traditional 1- or 2-handed mask-face sealing techniques, as well as a newer modified 2-handed technique. We compare the efficacy of 1-handed, 2-handed, and modified 2-handed bag-valve-mask technique.<h4>Methods</h4>In this prospective, crossover study, health care providers performed 1-handed, 2-handed, and modified 2-handed bag-valve-mask ventilation on a standar ...[more]

PMID: 23937957

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Project description:BACKGROUND:Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial. METHODS:In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%. RESULTS:Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P?=?0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P?=?0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P?=?0.73). CONCLUSIONS:Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. (Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.).

Project description:INTRODUCTION:Bag mask ventilation (BMV) and extraglottic devices (EGDs) are two common methods of providing rescue ventilation. BMV can be difficult to perform effectively, especially for inexperienced providers and in patients with difficult airway characteristics. There is some evidence that the laryngeal tube (LT) can be successfully placed by inexperienced providers to provide effective ventilation. However, it is unclear whether ventilation provided by LT is superior to that of BMV, especially in the hands of inexperienced airway providers. Therefore, we aimed to compare ventilation efficacy of inexperienced airway providers with BMV versus LT by primarily measuring tidal volumes and secondarily measuring peak pressures on a simulated model. METHODS:We performed a crossover study first year emergency medicine residents and third and fourth year medical students. After a brief instructional video followed by hands on practice, participants performed both techniques in random order on a simulated model for two minutes each. Returned tidal volumes and peak pressures were measured. RESULTS:Twenty participants were enrolled and 1200 breaths were measured, 600 per technique. The median ventilation volumes were 194 milliliters (mL) for BMV, and 387 mL for the laryngeal tube, with a median absolute difference of 170 mL (95% confidence interval [CI] 157-182 mL) (mean difference 148 mL [95% CI, 138-158 mL], p<0.001). The median ventilation peak pressures were 23 centimeters of water (cm H2O) for BMV, and 30 cm H2O for the laryngeal tube, with a median absolute difference of 7 cm H2O (95% CI, 6-8 cm H2O) (mean difference 8 cm H2O [95% CI, 7-9 cm H2O], p<0.001). CONCLUSION:Inexperienced airway providers were able to provide higher ventilation volumes and peak pressures with the LT when compared to BMV in a manikin model. Inexperienced providers should consider using an LT when providing rescue ventilations in obtunded or hypoventilating patients without intact airway reflexes. Further study is required to understand whether these findings are generalizable to live patients.

Project description:Airborne coal dust generated during mining can deposit and accumulate on mine surfaces, presenting a dust explosion hazard. When assessing dust hazard mitigation strategies for airborne dust reduction, sampling is done in high-velocity ventilation air, which is used to purge the mining face and gallery tunnel. In this environment, the sampler inlet velocity should be matched to the air stream velocity (isokinetic sampling) to prevent oversampling of coarse dust at low sampler-to-air velocity ratios. Low velocity ratios are often encountered when using low flow rate, personal sampling pumps commonly used in underground mines. In this study, with a goal of employing mine-ready equipment, a personal sampler was adapted for area sampling of coarse coal dust in high-velocity ventilation air. This was done by adapting an isokinetic nozzle to the inlet of an Institute of Occupational Medicine (Edinburgh, Scotland) sampling cassette (IOM). Collected dust masses were compared for the modified IOM isokinetic sampler (IOM-MOD), the IOM without the isokinetic nozzle, and a conventional dust sampling cassette without the cyclone on the inlet. All samplers were operated at a flow rate typical of personal sampling pumps: 2 L/min. To ensure differences between collected masses that could be attributed to sampler design and were not influenced by artifacts from dust concentration gradients, relatively uniform and repeatable dust concentrations were demonstrated in the sampling zone of the National Institute for Occupational Safety and Health experimental mine gallery. Consistent with isokinetic theory, greater differences between isokinetic and non-isokinetic sampled masses were found for larger dust volume-size distributions and higher ventilation air velocities. Since isokinetic sampling is conventionally used to determine total dust concentration, and isokinetic sampling made a difference in collected masses, the results suggest when sampling for coarse coal dust the IOM-MOD may improve airborne coarse dust assessments over "off-the-shelf" sampling cassettes.

Dataset Information

Comparison of bag-valve-mask hand-sealing techniques in a simulated model.

Publications

Comparison of bag-valve-mask hand-sealing techniques in a simulated model.

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