From mouth-to-mouth to bag-valve-mask ventilation: evolution and characteristics of actual devices--a review of the literature

Abstract

Manual ventilation is a vital procedure, which remains difficult to achieve for patients who require ventilatory support. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. We will give in this paper, a historical view on manual ventilation's evolution throughout the last decades and describe the technical characteristics, advantages, and hazards of the main devices currently found in the market. Artificial ventilation has developed progressively and research is still going on to improve the actual devices used. Throughout the past years, a brand-new generation of ventilators was developed, but little was done for manual ventilation. Many adverse outcomes due to faulty valve or misassembly were reported in the literature, as well as some difficulties to ensure efficient insufflation according to usual respiratory parameters. These serious incidents underline the importance of BVM system routine check and especially the unidirectional valve reassembly after sterilization, by only experienced and trained personnel. Single use built-in devices may prevent disassembly problems and are safer than the reusable ones. Through new devices and technical improvements, the safety of BVM might be increased.

Figure 1

Basic components of the BVM system (De Godoy et al. [11]).

Figure 2

Ambu single-shutter valve ((a) http://helid.digicollection.org/, (b) Kim et al., 2008 [16]).

Figure 3

Laerdal valve ((a) http://www.laerdal.com/, (b): Kim et al., 2008 [16]).