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Positive‐pressure ventilation during transport: a randomized crossover study of self‐inflating and flow‐inflating resuscitators in a simulation model
Author(s) -
Lucy Malcolm J.,
Gamble Jonathan J.,
Daku Brian L.,
Bryce Rhonda D.,
Rana Masud
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12461
Subject(s) - medicine , ventilation (architecture) , anesthesia , crossover study , peak inspiratory pressure , tidal volume , respiratory system , mechanical engineering , alternative medicine , pathology , engineering , placebo
Summary Background 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. Objective To evaluate the hypothesis that transport ventilation goals of intubated pediatric patients are better achieved using an FIR compared to an SIR. Methods 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 2 O). Secondary outcomes included proportion of total breaths delivered with operationally defined unacceptable breath variables (PIP > 35 cm H 2 O or PEEP < 5 cm H 2 O). Results 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 ( P < 0.0001 for both). Conclusions Hand ventilation during patient transport is superior using the FIR compared to the SIR to achieve target ventilatory goals and avoid unacceptable ventilatory cycles.