Positive‐pressure ventilation during transport: a randomized crossover study of self‐inflating and flow‐inflating resuscitators in a simulation model. Issue 12 (23rd June 2014)

• Record Type: Journal Article
• Authors: Lucy, Malcolm J.; Gamble, Jonathan J.; Daku, Brian L.; Bryce, Rhonda D.; Rana, Masud; Anderson, Brian
• Is Part Of: Paediatric anaesthesia. Volume 24:Issue 12(2014)
• Page Start: 1281
• Page End: 1287
• Publication Date: 2014-06-23
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12461
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12461-abs-0001"> <title>Summary</title> <sec id="pan12461-sec-0001" sec-type="section"> <title>Background</title> <p>Positive‐pressure ventilation during transport of intubated patients is generally delivered via a hand‐pressurized device. Of these devices, self‐inflating resuscitators (SIR) and flow‐inflating resuscitators (FIR) constitute the two major types used. Selection of a particular device for transport, however, remains largely an institutional practice.</p> </sec> <sec id="pan12461-sec-0002" sec-type="section"> <title>Objective</title> <p>To evaluate the hypothesis that transport ventilation goals of intubated pediatric patients are better achieved using an FIR compared to an SIR.</p> </sec> <sec id="pan12461-sec-0003" sec-type="section"> <title>Methods</title> <p>This randomized crossover simulation study compared the performance of SIR and FIR among anesthesia providers in a pediatric transport scenario. Subjects hand‐ventilated a test lung while simultaneously maneuvering a stretcher bed to simulate patient transport. Hand ventilation was carried out using a Jackson–Rees circuit (FIR) and a Laerdal pediatric silicone resuscitator (SIR). The primary outcome was the proportion of total breaths delivered within the predefined target PIP/PEEP range (30+/− 3, 10+/− 3 cm H<sub>2</sub>O). Secondary outcomes included proportion of total breaths delivered with operationally defined unacceptable breath variables (PIP > 35 cm H<sub>2</sub>O or PEEP < 5 cm H<sub>2</sub>O).</p> </sec> <sec id="pan12461-sec-0004" sec-type="section"> <title>Results</title> <p>Overall, participants were four times more likely to deliver target breaths and one‐third less likely to deliver unacceptable breaths using the FIR compared to the SIR. When comparing device performance, a 44% increase in the proportions of target breaths and a 40.4% decrease in unacceptable breaths using the FIR were observed (<italic>P</italic> < 0.0001 for both).</p> </sec> <sec id="pan12461-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Hand ventilation during patient transport is superior using the FIR compared to the SIR to achieve target ventilatory goals and avoid unacceptable ventilatory cycles.</p> </sec> </abstract>