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. 2024 Jul 24;69(8):924-930.
doi: 10.4187/respcare.11588.

Assessment of Ventilation Using Adult and Pediatric Manual Resuscitators in a Simulated Adult Patient

Joshua M Justice  1 , Arthur S Slutsky  2 , Nathan Stanford  3 , Christopher Isennock  3 , Sameer Siddiqui  4 , Hamza Zamir  4 , J Richard Walker 3rd  3 , Mark F Brady  5
Affiliations

Assessment of Ventilation Using Adult and Pediatric Manual Resuscitators in a Simulated Adult Patient

Joshua M Justice et al. Respir Care. .

Abstract

Background: The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device.

Methods: This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV).

Results: A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0-2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0-467.3] mL/min, P < .001).

Conclusions: Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject.

Keywords: bag-valve-mask; estimated alveolar ventilation; manual ventilation; simulated patient; tidal volume.

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Conflict of interest statement

Dr Slutsky discloses a relationship with SafeBVM Corporation. The remaining authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Cumulative distribution curve for the proportion of participants able to generate adequate tidal volume with adult and pediatric BVM.
Fig. 2.
Fig. 2.
Cumulative distribution curve for the proportion of participants able to generate estimated alveolar ventilation with adult and pediatric BVM.
See this image and copyright information in PMC

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