Bag-valve-mask Research Articles

Can bag-valve mask ventilation with positive end-expiratory pressure reduce hypoxia during intubation? A prospective, randomized, double-blind trial

BackgroundHypoxia is one of the life-threatening complications of endotracheal intubation. Supplemental oxygen and ventilation play a vital role in preventing hypoxia. Bag-valve mask (BVM) ventilation is frequently used before intubation, and its ability to improve oxygenation was recently confirmed. It is still unclear if positive end-expiratory pressure (PEEP) added to BVM ventilation can further reduce hypoxia during intubation.MethodsThis will be a prospective, randomized, double-blind trial to determine if PEEP combined with BVM ventilation can reduce the incidence of hypoxia during intubation compared with conventional BVM ventilation. The lowest oxygen saturation and incidence of complications will be compiled to verify the comparative effectiveness and safety of the two groups.DiscussionBMV ventilation with PEEP is hoped to further reduce the incidence of hypoxia during intubation.Trial registrationChinese Clinical Trial Registry ChiCTR2000035156. Registered on August 2, 2020. It had begun enrollment after passing ethical review but before registration.

Evolution and Characteristics of Bag-Valve-Mask Ventilation During Pandemic: A Review of the Literature

Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The introduction of patients with worsening lung function as a result of COVID-19 has strained traditional ventilator supplies. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. For patients who require ventilatory support, manual ventilation is a vital procedure. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. We will present, a historical view on manual ventilation’s evolution throughout the last decades. Artificial ventilation has developed progressively and research is still going on to improve the actual devices used. Throughout the past years, a brand-new generation of ventilators was developed, but little was done for manual ventilation. Manual ventilation through BVM can be replaced by automatic ventilation which illustrates that the Tidal Volume vs. Time graph of the automated system is similar to the graph produced by manual operation of the BVM and to the graph produced by a human subject. The use of an automatic manually operated device may improve ventilation efficiency and decrease the risk of pulmonary overdistention, while decreasing the ventilation rate.

Pediatric Deep Sedation for Ophthalmology Procedures in an Outpatient Setting, Risk Evaluation.

Background:Pediatric deep sedation (PDS) performed by a dedicated pediatric sedation service has been found to be safe, convenient, and efficient for minor procedures. Major complications such as cardiopulmonary resuscitation, intubation, and death are rare. However, minor complications such as desaturation, apnea, suctioning, or laryngospasm can occur infrequently. To date, little data exist evaluating PDS use for minor ophthalmology procedures.Aims:The aim of this study was to evaluate the incidence of complications for subjects receiving PDS for minor ophthalmology procedures.Setting:Pediatric children's hospital sedation service.Materials and Methods:This was a review of a prospectively collected database between 2018 and 2020. A hundred and thirty-four subjects aged 0–18 years, who underwent PDS for minor ophthalmology procedures, were compared to 1119 subjects who received PDS for other procedures (e.g., lumbar puncture, bone marrow aspirate/biopsy, and Botox).Statistical Analysis:SAS software, version 9.4, was used to determine variables associated with deep sedation that were predictive of complications. A multiple logistic regression procedure was conducted. Statistical significance was set at the 0.05 level.Results:Subjects receiving PDS for ophthalmology procedures had a higher rate of minor complications than the control group (n = 18, 13.4%, vs. n = 58, 5.7%; P < 0001). No major complications occurred in any of the studied subjects. The ophthalmology group had a higher rate of bag-mask ventilation, airway positioning, and suctioning.Conclusions:Ophthalmology procedures using PDS have a greater occurrence of minor complications compared to other painful procedures. No major complications were noted in either group, providing evidence that PDS can be performed safely for ophthalmology procedures using the sedation team model.

Design and Development of Mechanical Ventilator

Respiratory diseases and injury-induced respiratory failure constitute a significant public healthiness in both developed and fewer developed countries. Asthma, chronic obstructive pulmonary disease and other chronic respiratory conditions are spread globally. These conditions are exacerbated by pollution , smoking, and burning of biomass for fuel, all of which are on the rise in developing countries1,2 Patients with underlying lung disease may develop respiratory failure under a selection of challenges and should be supported mechanical ventilation. These are machines which mechanically assist patients inspire and exhale, allowing the exchange of oxygen and CO2 to occur within the lungs, a process mentioned as procedure. Design and prototyping of a inexpensive portable mechanical ventilator to be utilized in mass casualty cases and resource-poor environments. The ventilator delivers breaths by compressing a typical bag-valve mask (BVM) with a pivoting cam arm, eliminating the need for an individual's operator for the BVM. Now a days, COVID-19 is one among the main issue goes on, and during this disease ventilator is plays the important role. during this project report, we've focused on to style and development of semi-automatic low cost mechanical ventilator.

Effect of high-flow vs. low-flow nasal plus mouthguard oxygen therapy on hypoxaemia during sedation: amulticentre randomised controlled trial.

Whether high-flow vs. low-flow nasal oxygen reduces hypoxaemia for sedation during endoscopic retrograde cholangiopancreatography is currently unknown. In this multicentre trial, 132 patients ASA physical status 3 or higher, BMI > 30 kg.m-2 or with known or suspected obstructive sleep apnoea were randomly allocated to high-flow nasal oxygen up to 60 l.min-1 at 100% FI O2 or low-flow nasal oxygen at 4 l.min-1 . The low-flow nasal oxygen group also received oxygen at 4 l.min-1 through an oxygenating mouthguard, totalling 8 l.min-1 . Primary outcome was hypoxaemia, defined as Sp O2 < 90% regardless of duration. Hypoxaemia occurred in 7.7% (5/65) of patients with high-flow and 9.1% (6/66) with low-flow nasal oxygen (percentage point difference -1.4%, 95%CI -10.9 to 8.0; p = 0.77). Between the groups, there were no significant differences in frequency of hypoxaemic episodes; lowest Sp O2 ; peak transcutaneous carbon dioxide; hypercarbia (transcutaneous carbon dioxide > 2.66 kPa from baseline); requirement of chin lift/jaw thrust; nasopharyngeal airway insertion; bag-mask ventilation; or tracheal intubation. Following adjustment for duration of the procedure, the primary outcome remained non-significant. In high-risk patients undergoing endoscopic retrograde cholangiopancreatography, oxygen therapy with high-flow nasal oxygen did not reduce the rate of hypoxaemia, hypercarbia or the need for airway interventions, compared with combined oral and nasal low-flow oxygen.

Accuracy of STOP-Bang Questionnaire in Predicting Difficult Mask Ventilation: An Observational Study.

IntroductionDifficulty with bag-mask ventilation after the induction of general anesthesia and muscle relaxation places the patient at risk for a prolonged period of apnea and hypoxia and thus, at an increased risk of morbidity and mortality. This study was designed to assess the accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation (DMV) in patients receiving general anesthesia for elective surgical procedures.MethodsIt was a prospective cross-sectional, observational study conducted at a university teaching hospital. A total of 530 patients undergoing surgery under general anesthesia with endotracheal intubation were enrolled. STOP-Bang questionnaire was filled at pre-operative anesthesia assessment. Ease or difficulty of mask ventilation was assessed and documented by a senior resident responsible for intraoperative anesthetic management.ResultsOut of 530 patients, 139 (26.22%) had a STOP-Bang score of ≥ 3, of whom 55 (39.5%) were found to have DMV. Out of 391 patients with a STOP-Bang score of < 3, only 29 patients (7.5%) had DMV (P ≤0.001). Snoring, high blood pressure, BMI more than 35 kg/m2, age more than 50 years, neck circumference more than 40 cm, and male gender were significantly associated with DMV. The accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation was 78.68% (95% CI 74.99-81.95) with a negative predictive value of 92.58%. The sensitivity and specificity were found to be 65.48% and 81.17% respectively.ConclusionSTOP-Bang score has a high negative predictive value and can be very useful in ruling out the possibility of difficult mask ventilation.

Expired carbon dioxide during newborn resuscitation as predictor of outcome

AimTo explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome. MethodsObservational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0–30 s, 30.1–60 s and 60.1–300 s). ResultsAmong 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO2 added extra predictive information compared to HR alone. After 60 s, ECO2 lost significance when adjusted for HR. In 70% of newborns with initial ECO2 <2% and HR < 100 bpm, ECO2 reached ≥2% before HR ≥ 100 bpm. Survival at 24 h was reduced by 17% per minute before ECO2 reached ≥2% and 44% per minute before HR reached ≥100 bpm. ConclusionsHigher levels and a faster rise in ECO2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO2 increased before HR and may serve as an earlier predictor of survival.

Design of Low-cost Automated Ventilator Using AMBU-bag

Design of Low-cost Automated Ventilator Using AMBU-bag

Mechatronic Design and Active Disturbance Rejection Control of a Bag Valve-Based Mechanical Ventilator

Abstract This paper presents the mechatronic (mechanical and control system) design of a functional prototype of a portable mechanical ventilator to treat patients with a compromised respiratory function. The portable ventilator ensures adequate oxygenation and carbon dioxide clearance while avoiding ventilator-induced lung injury (VILI). Oxygen is delivered through the compression of a bag valve (Ambu bag) using a moving strap. Carbon dioxide is cleared through the control of a pinch valve actuated by a low-torque servomotor. The positive end-expiratory pressure (PEEP) is controlled by an adjustable mechanical valve of the system. An Arduino Mega microcontroller board is used in this prototype to control the respiratory variables. All mechanical components as well as sensors, actuators, and control hardware are of common use in robotics and are very inexpensive. The total cost of the prototype built in this work is about $425 U.S. dollars. The design is meant to be replicated and utilized in emergency conditions that involve an overwhelming number of cases, such as COVID-19 treatment, in places with no access to commercial mechanical ventilation (MV) technologies. In order to account for variations in the prototype as built, the software developed for this portable MV applies an active disturbance rejection control (ADRC) strategy. This control strategy is presented as a universal control structure for any mechanical ventilator able to supply air flow with controlled pressure and volume.

Early intubation versus late intubation for COVID-19 patients: An in situ simulation identifying factors affecting performance and infection control in airway management.

COVID-19 poses an infectious risk to healthcare workers especially during airway management. We compared the impact of early versus late intubation on infection control and performance in a randomised in situ simulation, using fluorescent powder as a surrogate for contamination. Twenty anaesthetists and intensivists intubated a simulated patient with COVID-19. The primary outcome was the degree of contamination. The secondary outcomes included the use of bag-valve-mask ventilation, the incidence of manikin cough, intubation time, first attempt success and heart rate variability as a measure of stress. The contamination score was significantly increased in the late intubation group, mean (standard deviation, SD) 17.20 (6.17), 95% confidence intervals (CI) 12.80 to 21.62 versus the early intubation group, mean (SD) 9.90 (5.13), 95% CI 6.23 to 13.57, P = 0.005. The contamination score was increased after simulated cough occurrence (mean (SD) 18.0 (5.09) versus 5.50 (2.10) in those without cough; P<0.001), and when first attempt laryngoscopy failed (mean (SD) of 17.1 (6.41) versus 11.6 (6.20) P = 0.038). The incidence of bag-mask ventilation was higher in the late intubation group (80% versus 30%; P=0.035). There was no significant difference in intubation time, incidence of failed first attempt laryngoscopy or heart rate variability between the two groups. Late intubation in patients with COVID-19 may be associated with greater laryngoscopist contamination and potential aerosol-generating events compared with early intubation. There was no difference in performance measured by intubation time and incidence of first attempt success. Late intubation, especially when resources are limited, may be a valid approach. However, strict infection control and appropriate personal protective equipment usage is recommended in such cases.

Systematic Review of Simulated Airway Management Whilst Wearing Personal Protective Equipment

(Br J Anaesth. 2020;125:e301–e305) Tracheal intubation is required in approximately 2.3% of COVID-19 patients. As COVID-19 is highly transmissible, airway management is high-risk for healthcare workers. The use of full personal protective equipment (PPE) is common among published recommendations for reducing the risk of transmission to healthcare workers during intubation. Other common recommendations include using video laryngoscopy with a distant screen display, avoiding manual bag-mask ventilation and involving senior staff. These recommendations were based on experiences from present and past pandemics rather than controlled studies. This systematic review aimed to evaluate current best practices for airway management while using PPE by reviewing studies using manikin-based simulation.

Computed Tomographic Findings of Injuries After Mechanical and Manual Resuscitation: A Retrospective Study.

IntroductionCardiopulmonary resuscitation (CPR)-related injuries are complications of chest compressions during CPR. This study aimed to investigate the differences and complications between mechanical and manual CPR techniques by using computed tomography (CT).MethodsPatients in whom return of spontaneous circulation was achieved after CPR and thorax CT imaging were performed for diagnostic purposes were included in the study.ResultsA total of 178 non-traumatic cardiac arrest patients were successfully resuscitated and had CT scans in the emergency department. The complications of CPR are sternum fracture, rib fracture, pleural effusion/hemothorax, and pneumothorax. There were no statistically significant differences in terms of age, first complaint, cardiac arrest rhythm, CPR duration, and complications between mechanical and manual CPR. The number of exitus in the emergency department was similar (p=0.638). The discharge from hospital rate was higher in the mechanical CPR group but there was no statistically significant difference (p=0.196). The duration of CPR was associated with the number of rib fractures and lung contusion, but it did not affect other CPR-related chest injuries.ConclusionThere was no significant difference observed in terms of increased complications in patients who received mechanical compression as compared with those who received manual compression. According to our results, mechanical compression does not cause serious complications, and the discharge from hospital rate was higher than for manual CPR; therefore, its use should be encouraged.

Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy.

PurposeAirway management is a key objective in adapted electroconvulsive therapy (ECT) protocols during the COVID-19 pandemic to prevent infection. The objective of this study was to describe the effectiveness of a modified ventilation procedure designed to reduce aerosol-generating bag-mask ventilation (BMV) and isolate possible droplets while maintaining adequate respiratory gas values in ECT sessions.Materials and MethodsThis prospective study analyzed the results of the modified protocol applied over a month. Adaptations entailed preoxygenation and extension of the voluntary hyperventilation (VHV) time for two minutes before anesthesia induction, asking patients to hyperventilate with oxygen therapy via nasal cannula and while wearing a face mask. Thereafter, vigorous hyperventilation was avoided, and patients were only assisted with tightly sealed BMV until emergence from anesthesia, isolating the ventilation by using a single-use plastic device. Oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) were recorded throughout the session.ResultsThe study included 74 sessions of bilateral ECT with the modified ventilation protocol in 15 subjects. After VHV, the mean SpO2 increase was 2.12±2.14%, and the mean TcPCO2 decrease was 4.05±2.98 mmHg. TcPCO2 values at the moment of stimulus administration were 2.22±3.07 mmHg below pre-ECT values. The mean EEG seizure was 38.70±17.03 s, and postictal suppression was 68.31± 34.58% and 2.13±0.75 on a 0–3 scale. Brief desaturation (SpO2 <90) of 4–5 seconds duration was observed in 4 sessions.ConclusionThis modified ventilation protocol was effective during COVID-19, and it did not elicit significant side effects. In addition to avoiding vigorous BMV, it induced moderate hypocapnia, which has been tied to seizure optimization and less hypercapnia during the apnea period.

Anesthetic Management of Apert Syndrome: A Case Report

Apert syndrome is a rare autosomal dominant disease associated with abnormalities of skull, face and limbs. These patients present for different types of surgeries. To the anesthesiologists,they pose special challenge during airway management, manifesting as difficulty in bag-mask ventilation and increased incidence of airway obstruction. Here, we report a case of a child with Apert syndrome undergoing syndactyly release under general anesthesia, in whom severe bronchospasm and a failed bag-mask ventilation occurred during the emergence of anesthesia requiring re-insertion of laryngeal mask airway.

Anesthetic Management of Apert Syndrome: A Case Report

Apert syndrome is a rare autosomal dominant disease associated with abnormalities of skull, face and limbs. These patients present for different types of surgeries. To the anesthesiologists,they pose special challenge during airway management, manifesting as difficulty in bag-mask ventilation and increased incidence of airway obstruction. Here, we report a case of a child with Apert syndrome undergoing syndactyly release under general anesthesia, in whom severe bronchospasm and a failed bag-mask ventilation occurred during the emergence of anesthesia requiring re-insertion of laryngeal mask airway.

A randomised trial of laryngeal mask airway in neonatal resuscitation.

Birth asphyxia is the leading cause of neonatal mortality in low-income countries.1 Improving resuscitation and outcomes from neonatal resuscitation at birth are crucial.2 Asphyxiated newborns often require bag-mask ventilation (BMV) as part of their initial resuscitation. When this fails, intubation is necessary. However, intubation is a difficult skill to practice especially for non-doctor staff present at delivery in low-income countries.2 Thus, improving the effectiveness of initial efforts to provide ventilation in asphyxiated newborn may decrease the need for extensive resuscitation and improve neonatal outcomes. Previous studies have shown an LMA is effective in providing positive pressure ventilation (PPV) ventilation at delivery,3 while other benefits of an LMA include ease of placement, minimal trauma, less air leak and improved seal.4 In this study, Pejovic et al. tested whether PPV provided in low-income countries by midwives using an LMA was superior to BMV. This large, RCT demonstrated that using an LMA to provide PPV at birth by midwives in neonates with asphyxia did not decrease mortality and morbidity when compared with facemask ventilation at birth. Although the current study did not show a benefit of using an LMA for initial resuscitative efforts when compared with facemask ventilation, it still may have a role in providing PPV at birth in low-income countries. The current phase three trial was done at a high volume delivery hospital in Uganda. Whether conducting the study in a hospital with low volume where midwives are less familiar with traditional BMV would have a different result is unknown. Furthermore, access to foetal monitoring would have increased the pre-test probability of birth asphyxia and potentially increased the ability of the study to detect a therapeutic effect. Previous studies have shown an LMA can be used in place of intubation for advanced airway management; it would be interesting to know if the transition from initial resuscitation to advanced resuscitation was improved with use of an LMA. Additional studies are needed to determine effectiveness of an LMA ventilation in infants with asphyxia with different study design, including foetal monitoring, patient selection, resuscitative steps and selection of hospital. This study shows an LMA can be used safely by midwives for providing ventilation at birth as measured by these short-term in-hospital experience. Along with these short-term morbidity and mortality data, assessment of long-term outcomes is needed. Furthermore, it would be interesting to know whether additional studies of an LMA vs facemask ventilation at birth would demonstrate a beneficial role for an LMA in neonatal resuscitation. Finally, although an LMA ventilation provided by midwives at birth in neonates with asphyxia while not superior to facemask ventilation with regard to in-hospital morbidity and mortality in low-income countries, it was shown to be safe, which opens the door to future study of an LMA in neonatal resuscitation in low-income countries. https://ebneo.org/laryngeal-mask-airway None.

Mechanical Ventilator for Respiratory Impaired Persons: A Review

Mechanical ventilator is one of the most important devices used in anesthesia and intensive care units for generating a regulated flow of gas into a patient’s lungs. Oxygen is required by every human to stay alive and in cases where a patient is undergoing an acute respiratory distress, a mechanical ventilator is used to deliver external ventilation which could be generated from a hospital’s built in supply system or from a portable oxygen generator. The ventilator is connected to the patient’s lungs through an endotracheal tube (ETT) to deliver air by compressing a conventional bag-valve mask (BVM) with a pivoting cam arm, thereby eliminating the need for a human operator. The device also operates by setting some parameters which can be predetermined by clinicians as well as an assist control mode and an alarm to determine when the system is over pressured. The paper focuses on review of Mechanical ventilators, the different modes of ventilation, anatomy tract of the respiratory system, respiratory mechanics, and approaches of ventilation.

Effect of High-Flow Nasal Cannula Oxygen Therapy on Pediatric Patients With Congenital Heart Disease in Procedural Sedation: A Prospective, Randomized Trial

ObjectivesThe study was conducted to compare the outcome of high-flow nasal cannula (HFNC) oxygen therapy with conventional oxygen therapy through a simple oxygen mask for pediatric patients with congenital heart disease during percutaneous intervention while under procedural sedation. DesignProspective, randomized and controlled trial. SettingA Cantonese cardiac center in China. ParticipantsTwo hundred American Society of Anesthesiologists classification II pediatric patients were enrolled from April 25, 2018 to November 28, 2018. InterventionsPatients scheduled for percutaneous closure of a heart defect under deep sedation with propofol, midazolam and fentanyl by an anesthesiologist were randomized (1:1) to receive oxygen therapy through a simple oxygen mask or through the HFNC system. Measurements and Main ResultsThe primary outcome was the lowest oxygen saturation (SpO2). Secondary outcomes included the incidence of hypoxia (SpO2 < 90%), requirement for noninvasive respiratory support, change in the gastric antrum area and other adverse events. Blood gas analysis results also were compared. Oxygen therapy through the HFNC system improved the lowest SpO2 (99% [94%-100%]), as compared with the mask group (99% [72%-100%]), p < 0.001. Seven patients out of 99 (7.1%) in the mask group had hypoxia or required bag-mask ventilation, whereas no such patient was reported in the HFNC group, p < 0.001. There were no differences between the groups in terms of gastric distention, procedure length, total propofol dose, atropine use or other complications. ConclusionWhen compared with simple mask oxygenation, HFNC could reduce the incidence of desaturation, the need for airway assisted ventilation and risk of carbon dioxide retention without causing hemodynamic instability or gastric distention. It is effective for pediatric patients with non-cyanotic congenital heart disease who require procedural sedation.

Difficult airway predictors were associated with decreased use of neuromuscular blocking agents in emergency airway management: a retrospective cohort study in Thailand

BackgroundIt is recommended that difficult airway predictors be evaluated before emergency airway management. However, little is known about how patients with difficult airway predictors are managed in emergency departments. We aimed to explore the incidence, management and outcomes of patients with difficult airway predictors in an emergency department.MethodsWe conducted a retrospective study using intubation data collected by a prospective registry in an academic emergency department from November 2017 to October 2018. Records with complete assessment of difficult airway predictors were included. Two categories of predictors were analyzed: predicted difficult intubation by direct laryngoscopy and predicted difficult bag-mask ventilation. The former was evaluated based on difficult external appearance, mouth opening and thyromental distance, Mallampati score, obstruction, and limited neck mobility as in the mnemonic “LEMON”. The latter was evaluated based on difficult mask sealing, obstruction or obesity, absence of teeth, advanced age and reduced pulmonary compliance as in the mnemonic “MOANS”. The incidence, management and outcomes of patients with these difficult airway predictors were explored.ResultsDuring the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature. Among patients with at least one difficult airway predictor, both sedation and neuromuscular blocking agents were used in 105 (57.4%) encounters, only sedation was used in 65 (35.5%) encounters, and no medication was administered in 13 (7.1%) encounters. First-pass success was accomplished in 136 (74.3%) of the patients. Compared with patients without predictors, patients with positive LEMON criteria were less likely to receive neuromuscular blocking agents (OR 0.46 (95% CI 0.24–0.87), p = 0.02) after adjusting for operator experience and device used. There were no significant differences between the two groups regarding glottic view, first-pass success, or complications. The LEMON criteria poorly predicted unsuccessful first pass and glottic view.ConclusionsIn emergency airway management, difficult airway predictors were associated with decreased use of neuromuscular blocking agents but were not associated with glottic view, first-pass success, or complications.

Newborn resuscitation devices: The known unknowns and the unknown unknowns

Infant resuscitation devices used at birth must be capable of delivering adequate and consistent ventilation in a controlled and predictable manner to a wide patient weight range, and combinations of transitional lung states. Manual inflation resuscitation devices delivering positive pressure lung inflation at birth can be classified broadly into two types: 1) flow generating, ie silicone self-inflating bags (SIB) also known as bag valve mask (BVM) and 2) flow dependent, ie anaesthetic flow inflating bag (FIB) and t-piece resuscitator (TPR) systems (eg: Neopuff, GE Panda and Draeger Resuscitaires). Globalization, lower production costs, and an expanding market need for devices, has led to a proliferation of brands (both reusable and single use) within a class type. T-piece resuscitators have become the dominant device particularly in high income countries. There remains a paucity of information on the performance characteristics of these devices and their ability to provide the required respiratory parameters for effective and safe ventilation across the full-expected weight range and lung states to which they will be applied. This review aims to inform current clinical practise on the biomechanical efficiency, reliability and efficacy of the most common devices used to apply PPV to newborns and infants ≤10 kgs.