Open AccessRaising the awareness for insufficient oxygen delivery from self‐inflating resuscitation bags lacking expiratory valve during preoxygenation
Author(s) -
Yip YuYeung,
Lee Christopher PakTo,
Cheung Jonathan ChunHei
Publication year - 2023
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/10249079221096918
Subject(s) - medicine , anesthesia , positive end expiratory pressure , intubation , port (circuit theory) , ventilation (architecture) , peak inspiratory pressure , resuscitation , tracheal intubation , oxygen delivery , breathing , mechanical ventilation , oxygen , respiratory system , tidal volume , mechanical engineering , chemistry , electrical engineering , organic chemistry , engineering
We recently read an interesting study which demonstrated that self‐inflating resuscitation bag (SIRB) lacking expiratory valve has unreliable performance in oxygen delivery during spontaneous breathing mimicked by mechanical lung simulator. It was postulated that the absence of an expiratory valve and the resulting air entrainment via the exhaust port accounts for the poor oxygen delivery performance. The current disposable SIRB in‐use in our institutions (Med‐Rescuer Disposable BVM Resuscitator 4000, BLS Systems Limited, ON, Canada) has a duckbill valve but no expiratory valve. Safety concerns regarding its oxygen delivery performance during spontaneous breathing were raised, as this SIRB was commonly used to preoxygenate critically ill patient with potentially transmissible respiratory infection (e.g. COVID‐19) before tracheal intubation. We therefore performed an experiment on this SIRB using one of us as a healthy volunteer. Our small experiment demonstrated that air entrainment could occur via the exhaust port and affect oxygen delivery performance. Our experiment also demonstrated that attaching a positive end‐expiratory pressure (PEEP) valve to the exhaust port improves the oxygen delivery performance. The findings of this experiment were sent to the relevant department of our institutions for safety consideration.