PT  - JOURNAL ARTICLE
AU  - Justice, Joshua M
AU  - Slutsky, Arthur S
AU  - Stanford, Nathan
AU  - Isennock, Christopher
AU  - Siddiqui, Sameer
AU  - Zamir, Hamza
AU  - Walker, J Richard
AU  - Brady, Mark F
TI  - Assessment of Ventilation Using Adult and Pediatric Manual Resuscitators in a Simulated Adult Patient
AID  - 10.4187/respcare.11588
DP  - 2024 Apr 30
TA  - Respiratory Care
PG  - respcare.11588
4099  - http://rc.rcjournal.com/content/early/2024/04/30/respcare.11588.short
4100  - http://rc.rcjournal.com/content/early/2024/04/30/respcare.11588.full
AB  - BACKGROUND: The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device.METHODS: This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV).RESULTS: A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0–2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0–467.3] mL/min, P < .001).CONCLUSIONS: Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject.