Quality of Ventilations during Infant Resuscitation: A Simulation Study Comparing Endotracheal Tube with Face Mask

Abstract

Background: There are few studies that analyze ventilation volume and pressure during CPR carried out on infants. The aim of this study was to evaluate the quality of the ventilations administered using a self-inflating bag with an endotracheal tube and a face mask in manikins. Methods: a quasi-experimental simulation study with a randomized case crossover design [endotracheal tube (ET) vs. face mask (FM)] was performed. Sixty participants who were previously trained nursing students participated in the study. The estimated air volumes breathed, and the pressure generated during each ventilation were assessed and the quality of the chest compressions was recorded. Results: the ET test presented a higher percentage of ventilations that reached the lungs (100% vs. 86%; p < 0.001), with adequate volume (60% vs. 28%; p < 0.001) in comparison to FM. Both tests presented peak pressures generated in the airway greater than 30 cm H2O (ET: 22% vs. FM: 31%; p = 0.03). Conclusions: performing quality CPR ventilations on an infant model is not an easy skill for trained nursing students. Both tests presented a significant incidence of excessive peak pressure during ventilations. Specific training, focused on quality of ventilations guided by a manometer attached to the self-inflating bag, must be considered in life support training for pediatric providers.

Impact of Two Resuscitation Sequences on Alveolar Ventilation during the First Minute of Simulated Pediatric Cardiac Arrest: Randomized Cross-Over Trial

“…Nevertheless, ventilations are not necessarily effective, and their volume can markedly vary from one ventilation attempt to another. A recent simulation study by Santos-Folgar et al showed that insufflations delivered using BVM devices failed to reach the alveoli 14% of the time and that the volume of 72% of these ventilations was considered insufficient [ 25 ]. In the present study, ventilations were applied by professional prehospital providers, and the proportion of ventilations below the 30 mL target were very low (less than 5%).…”

Effect of Intermediate Airway Management on Ventilation Parameters in Simulated Pediatric Out-of-Hospital Cardiac Arrest: Protocol for a Multicenter, Randomized, Crossover Trial

“…These devices present several drawbacks. Difficulties in ventilating with a BVM are not uncommon [10], with a significant incidence of excessive or insufficient (in terms of volume and/or pressure) ventilations [11]. Air leaks are frequently encountered when using basic airway management devices and are associated with lower and often unsatisfactory tidal volumes [12].…”