Clinical application of a connection device consisting of a bag valve mask and nebulizer in first aid: Two case reports

Abstract

In clinical practice, several emergencies may threaten the life of patients, and these emergencies can be unpredictable and challenging. During the coronavirus disease 2019 pandemic, in January 2023, a patient developed respiratory distress caused by coronavirus, but was unable to access respiratory support due to shortages of medical resources, intensive care unit beds and ventilators. The medical staff quickly created a portable high-flow atomized oxygen therapy apparatus consisting of a simple breathing bag connected to a nebulizer to provide breathing support. In addition, the Ambulatory Surgery Center, The First Affiliated Hospital of Anhui Medical University (Hefei, China) witnessed a case of severe laryngeal spasm after tracheal extubation during the recovery period from general anesthesia. Due to the lack of an anesthesia machine nebulizer, the aforementioned device was used to provide oxygen under pressure and initiate treatment to quickly relieve the symptoms of laryngeal obstruction. The present case report describes how the medical staff quickly applied emergency airway management skills and knowledge to create a portable high-flow atomized oxygen therapy apparatus in a resource-poor setting to save the lives of two patients.

Keywords: case report; emergency intervention; nebulization; oxygen therapy.

Figure 1

Computed tomography scans of the patient at different levels. Patchy fuzzy shadows with unclear boundaries and uneven internal density were observed in both lungs, especially in the lobus inferior pulmonis.

Figure 2

Steps taken to create the custom-made high-flow oxygen nebulization device: (A) The pressure safety valve of the sterile adult BVM was removed; (B) the outer diameter of the mask was wrapped with adhesive tape; (C) the nebulizer with nebulization solutions was connected to the BVM; (D) the duckbill valve outlet was connected to the catheter mount connected to a mask; and (E) the two breathing tubes were connected to the nebulizer and the inlet of the BVM. BVM, bag valve mask.

Figure 3

Changes in TcPO₂ and TcPCO₂ 30 min after the custom-made high-flow-rate oxygen nebulization device was replaced by an HFNC. HFNC, high-flow nasal cannula; TcPCO₂, transcutaneous partial pressure of carbon dioxide; TcPO₂, transcutaneous oxygen pressure.

Figure 4

Anesthetic machine nebulizer and custom-made atomizer: (A) Special atomizer for the anesthesia machine. (B) Custom-made atomizer: The balloon of the BVM was removed and the duckbill valve head was inserted into the intake end of the anesthesia machine for nebulization treatment.