Manual Ventilation and Sustained Lung Inflation in an Experimental Model: Influence of Equipment Type and Operator’s Training

Abstract

AimTo compare the influence of devices for manual ventilation and individual experience on the applied respiratory mechanics and sustained lung inflation.MethodsA total of 114 instructors and non-instructors from the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics participated in this study. Participants ventilated an intubated manikin. To evaluate respiratory mechanics and sustained lung inflation parameters, a direct comparison was made between the self-inflating bag and the T-shaped resuscitator (T-piece), followed by an analysis of the effectiveness of the equipment according to the participants’ education and training.ResultsA difference between equipment types was observed for the tidal volume, with a median (interquartile range) of 28.5 mL (12.6) for the self-inflating bag and 20.1 mL (8.4) for the T-piece in the instructor group and 31.6 mL (14) for the self-inflating bag and 22.3 mL (8.8) for the T-piece in the non-instructor group. Higher inspiratory time values were observed with the T-piece in both groups of professionals, with no significant difference between them. The operator’s ability to maintain the target pressure over the 10 seconds of sustained lung inflation was evaluated using the area under the pressure-time curve and was 1.7-fold higher with the use of the T-piece. Inspiratory pressure and mean airway pressure applied during sustained lung inflation were greater with the self-inflating bag, as evaluated between the beginning and the end of the procedure.ConclusionThe T-piece resulted in lower tidal volume and higher inspiratory time values, irrespective of the operator’s experience, and increased the ease of performing the sustained lung inflation maneuver, as demonstrated by the maintenance of target pressure for the desired period and a higher mean airway pressure than that obtained using the self-inflating bag.

Dispositivi manuali o meccanici per la ventilazione nella rianimazione neonatale: una revisione narrativa

“…IL pallone va e vieni è generalmente monouso, il suo utilizzo è direttamente collegato all'intubazione e può essere usato solo da personale sanitario specificatamente addestrato [22] . A differenza dei dispositivi manuali, il rianimatore a T, essendo un dispositivo automatico, eroga ventilazioni più precise e prestanti in quanto i valori che vengono impostati a priori sul macchinario [11] garantiscono una ventilazione continua controllata [24] . In uno studio si evince che l'utilizzo di questo dispositivo per la rianimazione neonatale ha diminuito di 2/3 la mortalità e la morbilità dei neonati [13] .…”

Paramedics' Newborn Life Support Knowledge and Skills Before and After a Targeted Simulation-Based Educational Intervention

“…Barotrauma due to excessive peak inspiratory pressures is one of the contributing factors for the development of chronic lung injury (18). The choice of the ventilation device also contributes to the quality of manual ventilation, as applied tidal volumes and peak inspiratory pressures are higher when using a self-inflating bag compared to a T-piece system (19, 20). Therefore, it would have been of great interest to not only measure face mask leakage in our study, but also delivered tidal volume and peak inspiratory pressure; unfortunately this was not feasible, as these parameters are measured and displayed graphically, but are neither shown numerically on the computer screen nor saved for later analysis in the first version of the SMART system.…”

Design for the Automation of an AMBU Spur II Manual Respirator

“…When the bag is compressed repeatedly by an operator's hand, it assists the patient with their breathing cycle [5]. These devices exist in various sizes that suit different ages and air volumes [6,7]. Manual respirators are meant to be used only during emergencies, given the inconvenience of requiring the constant implication of an operator that can become exhausted after protracted periods of time [8][9][10].…”