Comparison of efficacy of three devices of manual positive pressure ventilation: a mannequin-based study.

Swarnarekha Bhat,Saudamini V Nesargi,Somashekhar M Nimbalkar,Suman Rao PN,Ashish R Dongara

doi:10.1186/s13052-015-0131-9

Swarnarekha Bhat, Saudamini V Nesargi + Show 3 more

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https://doi.org/10.1186/s13052-015-0131-9

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Abstract

BackgroundWe compared the efficacy of and consistency in manual ventilation by trained healthcare professionals using three devices: self-inflating bag, flow-inflating bag, and T-piece resuscitator.MethodsProspective analytical study at a level III Neonatal unit of a tertiary care hospital. Forty participants (consultants, postgraduates, interns, and neonatal nurses – 10 each) manually ventilated a mannequin with the above three devices for three minutes each. This procedure was video recorded. The pressure delivered during the three minutes and the breath rates for the first minute, second minute, and third minute were analyzed. Descriptive statistics were used to describe the study population and group statistics were used for various parameters of interest. Factorial analysis of variance was conducted to determine the main effects of device and specialty of users.ResultsThe mean (SD) peak inspiratory pressure of T-piece resuscitator was 16.5 (1.2), self-inflating bag (SIB) was 20.7 (4.4), and flow-inflating bag (AB) was 21.2 (5.0). The mean (SD) positive end expiratory pressure of T-piece resuscitator was 4.7 (0.9) cm of H2O and AB was 1.8 (1.7) cm of H2O. The maximum pressure delivered by T-piece resuscitator was 17.5, AB was 26.2, and SIB was 25.2 cm of H2O. Clinically appropriate breath rates were delivered using all of the devices. More effective breath rates were delivered using T-piece. There was no significant difference among the professional groups.ConclusionsThe T-piece resuscitator provides the most consistent pressures and is most effective. Level of training has no influence on pressures delivered during manual ventilation.

Highlights

We compared the efficacy of and consistency in manual ventilation by trained healthcare professionals using three devices: self-inflating bag, flow-inflating bag, and T-piece resuscitator
All three devices have their own advantages and shortcomings. Improper use of these devices can lead to barotrauma and volutrauma (because of high peak inspiratory pressures (PIP) and tidal volume (TV)), atelectotrauma (due to improper positive end expiratory pressure (PEEP)), and super oxygenation injuries to the lung and other organs [6,7]
Ltd. (India) without a Peak end expiratory pressure (PEEP) valve and with a pop off valve set at 30–35 cm of H2O, Fisher & Paykel (USA), infant T-piece resuscitator – 900 series known as NeopuffTM, and anesthetic bags (AB) known as Jackson Rees bag were used

Summary

Introduction

We compared the efficacy of and consistency in manual ventilation by trained healthcare professionals using three devices: self-inflating bag, flow-inflating bag, and T-piece resuscitator. The remaining 10% require some form of support, of which 1% require extensive resuscitation including positive pressure ventilation [1]. The most commonly used devices for providing manual positive pressure ventilation are self-inflating bags (SIB), flow-inflating or anesthetic bags (AB), and T-piece resuscitators [4]. They are essential during neonatal resuscitation, and for assessment and management during acute deterioration, equipment failure, and transport [5]. All three devices have their own advantages and shortcomings. The pressure delivered depends on method of delivery as well as the operators involved [8]

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