Abstract
Background: Manual ventilation is a basic and vital skill for respiratory therapists (RTs). High peak pressures delivered via bag valve mask (BVM) can be dangerous for pediatric patients and lack of adequate oxygenation and/or ventilation can lead to death.1 At our institution, significant variability between manual ventilation of neonatal and pediatric patients has been observed. We aimed to examine ventilation techniques via a non-self-inflating manual resuscitation device to provide education and instruction in an effort to standardize optimal practice within our department and evaluate response to hands-on training.
Methods: RT BVM performance was evaluated in the emergency department skills station at our annual skills fair. In the station, RTs were randomly given 2 of 3 scenarios (Table 1) and instructed to manually ventilate a Michigan test lung (compliance 0.5 L/cm H2O) for 60 s via non-self-inflating BVM while data was recorded via Pneuview 3.2 software. After initial scenario, education was provided on expected targets and the RT repeated the scenarios. In an IRB approved retrospective analysis, RT data from days 1 and 2 (4/12/2021 and 4/13/2021) of the skills fair were reviewed and evaluated for BVM RR, PIP, and PEEP from RT manual ventilation pre and post education.
Results: A total of 9 data sets were analyzed for 52 RTs, for which 3 showed statistical significance (Figure 1). In scenario A, PIP prior to education was 16.5 cm H2O compared to a post education PIP of 5.7 cm H2O (P 0.0221). In scenario B, BVM RR prior to education was 30.1 compared to post education BVM RR of 23.3 (P 0.0057). In scenario C, BVM RR prior to education was 42.4 compared to post education BVM rate of 16.4 (P 0.0078). Standard deviations decreased in 7 of the 9 data sets showing increased consistency post education.
Conclusions: Improper manual ventilation techniques can result in harm and/or physiological impairment to patients. After providing critical feedback and standardized BVM goals for RR, PIP, and PEEP variability of BVM techniques between participants decreased which supported delivery of optimal manual BVM ventilation. Further studies should be done to assess effective BVM skill set amongst other disciplines and in real time. Reference: Culbreth R, Gardenhire D. Manual bag valve mask ventilation performance among respiratory therapists. Heart Lung 2021;50 (3):471-475.
Figure 1 displays the average PIP, PEEP and RR for BVM ventilation from RTs before and after education of targets
Footnotes
Commercial Relationships: Katlyn Burr, Patient Trainer- HillRom
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