Manual Ventilation Performance With Safety Device in Normal Versus Decreased Lung Compliance: A Single-Center Simulation Study.

Abstract

Background: Resuscitator bags are commonly utilized in acute care settings; however, poor performance occurs irrespective of a provider's qualifications or experience. A new flow-limiting device (Sotair by SafeBVM, Boston, Massachusetts) limits inspiratory flow during manual ventilation, thus minimizing peak inspiratory pressures. This study examined the differences in flow, pressure, and tidal volume (V_T) during ventilation with a manual resuscitator connected to the flow-limiting device versus a mechanical ventilator. Methods: Second-year respiratory therapy students were recruited from an advanced cardiovascular life support class. Participants conducted a 2-min trial of manually ventilating a test lung utilizing normal and decreased compliance settings with the flow-limiting device connected to an endotracheal tube. Demographic data on participants' age were collected. The control group consisted of a mechanical ventilator providing ventilation with the same test lung and compliance settings. Mean differences were compared between the manual ventilation and control group. Results: A total of 41 respiratory therapy students (71% female, 76% undergraduate) participated. The mean experience level using the bag-valve-mask was 6.71, and the mean confidence level was 8.02; the scale was 0-10 with high numbers indicating greater experience or confidence. A small but statistically significant difference was found in mean peak pressures between manual ventilation with the flow-limiting device (15 cm H₂O) and the mechanical ventilator (13 cm H₂O) for the normal lung setting (P = .008) but not for the decreased compliance lung setting (23 cm H₂O vs 23 cm H₂O with the ventilator). There was a significant difference in mean V_T between manual ventilation (412 mL) and the mechanical ventilator (460 mL) in the decreased compliance lung setting (P = .003) but not the normal compliance setting (452 mL vs 474 mL with the ventilator). Conclusions: Although there were some statistically significant differences between the 2 groups, these differences were not clinically important. Participants adequately manually ventilated with V_T similar to a mechanical ventilator.