The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

MANUAL VENTILATION TECHNIQUE VARIABILITY IN A PEDIATRIC LUNG MODEL

Jim Keenan RRT, BS, John W. Salyer RRT, BS, MBA, FAARC, Todd Ashby CRTT, Joe Withers CRTT, Natalie Bee, CRTT. Primary Children's Medical Center, Salt Lake City, UT, Weber State University, Ogden, UT.

Introduction: Debate continues among clinicians and disciplines regarding the merits of self-inflating (SI) and non self-inflating (NSI) resuscitation bags. We sought to test ventilation variability between two clinical disciplines (Respiratory and Nursing) using SI and NSI resuscitation bags in a pediatric lung model.

Methods: We compared the bagging techniques of 20 nurses and 9 RCPs from our Pediatric Intensive Care Unit using a pediatric lung model. The bag types were SI (Baxter) and NSI (Drager, Rusch). We used a Michigan test lung and instructed subjects to achieve Vt=250 ml, PEEP=4, f=30. PEEP was controlled on the SI bag by using a PEEP valve, and on the NSI by flow into an out of the bag. Each subject used both bags, and data were gathered for 8-10 minutes for each. Vt and PEEP were measured and stored via computerized pneumotachography (Ventrak, Novametrix Inc.). Results: 7124 breaths were analyzed. We found statistically significant differences in Vt and PEEP between the two bag types and between disciplines with each bag type (Mann-Whitney U test, all P values < 0.01). The distribution of Vt and PEEP sorted by discipline and bag type is presented in figure 1. Mean ± SD and Coefficients of Variation (SD/Mean) are represented in table 1.

Vt (SD) (VC) PEEP (SD) (VC)
RCP NSI 253.2 (±33.7) (0.13) 3.8 (±2.0) (0.53)
RCP SI 238.7 (±31.4) (0.132) 4.6 (±1.9) (0.24)
Nursing NSI 215.3 (±55.6) (0.26) 3.8 (±2.0) (0.53)
Nursing SI 234.1 (±50.1) (0.21) 4.6 (±0.9) (0.20)
Table 1: Vt and PEEP Mean ± SD and Coefficients of Variation (CV).

Discussion: There is noted variability in Vt and Peep using the NSI and less using the SI bags between both disciplines. There is less variability using the SI bag between both disciplines. There is also noted variability between disciplines for both bag types. While our findings were statistically significant, clinical importance is difficult to analyze. These data may suggest that RCPs provide manual ventilation that is less variable than nurses and the use of SI bags may be more effective than NSI.

(See Original for Figure)

OF-99-211

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