2006 OPEN FORUM Abstracts
COMPARISON OF VENTILATION USING FLOW DEPENDENT AND SELF INFLATING BAGS IN A PEDIATRIC EMERGENCY SCENARIO
Ahlsten KT CRT,
CPFT, Appelquist JR CRT, Cua AT CRT, CPFT, Helm RA CRT, Patterson EL CRT,
Findlay JY, M.B.Ch.B.
Background: Care providers working in pediatric
areas are expected to be competent in providing ventilation using both
anesthesia bag and self inflating bags apparatus. Previous research suggests that during
simulated bag-mask ventilation appropriate ventilation is more often performed
using a self-inflating bag. How
practitioners perform during a scenario with an intubated patient is
unknown. We compared the adequacy of
ventilation by pediatric care providers in a simulated pediatric code with an
endotracheal tube using both the anesthesia bag and the self-inflating bag
apparatus. Our hypothesis was that the
frequency of inappropriate ventilation would be greater with the anesthesia bag
apparatus.
Methods:
Volunteers with PALS certification were asked to ventilate a pediatric
patient in a code scenario following the PALS protocol for two minutes. They
were told that the patient was a 12 month old, 10 kilogram, 75
cm child with normal lung function.
They performed this scenario
twice, once using a 0.375 L pediatric self inflating bag with peep valve
(Portex, Keene, New Hampshire) and once using a 0.5 L pediatric flow dependent
(anesthesia) bag (Anesthesia Associates, San Marcos, California). The bags were attached to an Ohmeda lung
simulator (Ohmeda, Harlow Essex, England) set at a compliance of 50 mL/cm H2O
and a resistance of 20 cm H2O/L/sec. Ventilation data was collected
using a Ventcheck (Novametrix/Respironics, Wallingford, Connecticut). Tidal volumes and peak inspiratory pressures
were collected every 10s, and frequency
was averaged over 2 one minute periods.
Inappropriate ventilation was
defined as a tidal volume less than 4 mL/Kg or greater than 10 mL/Kg a
frequency less than 15 or greater than 30 and
minute ventilation greater than 1.2 L/min or less than 4 L/min.
Inappropriately high airway pressure was defined as a peak pressure greater
than 30 cmH2O.
Results: Thirty-five practitioners
completed the study. Appropriate tidal
volumes were delivered by 3 (9%) participants using the self-inflating bag and
3 using the flow dependent bag, the remaining tidal volumes were high. An appropriate frequency was delivered by 15
(43%) participants using the self-inflating bag and 11 (31%) using the flow
dependent bag. One participant delivered
a low frequency, the remainder were high. Appropriate minute ventilation was delivered
by 2 (6%) participants using the self-inflating bag and 5 (14%) using the
flow-dependent bag. Inappropriately high
airway pressure was delivered at least once by 4 (11%) participants using the
self-inflating bag and 7 (20%) using the flow-dependent bag. There were no significant differences in the
frequency of any inappropriate ventilation measures between the two bags.
Conclusions: In the simulated scenario given the
majority of trained participants hyperventilated. There was no difference in performance using
either a self-inflating bag or a flow-dependent bag. Improvements in staff training are needed in
the importance of proper ventilation, and the need to be competent with all
available equipment.