The Science Journal of the American Association for Respiratory Care

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.


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