The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

MEASUREMENT OF PEEP ON MANUAL VENTILATION SYSTEMS

Rodrigo S. Adasme; Respiratory Care, Catholic university Hospital, Santiago, Chile

Introduction:Manual ventilatory support (MVS) is done by all members of the health care team in Critical Care Units. The ability of these devices to generate and maintain PEEP is still an open question Methods: We measured 3 devices: Adult self inflate bag (ASIB) (Hudson RCI. Durham. NC); Adult self inflatable bag and PEEP valve, (ASIBP) (Hudson RCI. Durham.NC); and Flow inflated bag, FIB (Vital Signa.Totowa,NJ). All connected 10 lpm O2 and a manometer (DHD Wampsville,NY) to give feedback to the operator. MIP, PEEP and RR were recorded and analyzed with a proximal pressure/flow sensor Varflex Bicore CP 100 blinded. Shape of the curve was was measured with a pressure monitor GE Dash 3000, blinded. 3 independent, well-trained RT’s were asked to generate MVS with MIP 30 cmH20 and keep PEEP of 0,5,10,15&20 cmH2O stepwise with an initial RR of 15 bpm, then 30 bpm for 1 minute for each PEEP. Adult test lung was ventilated (Siemens-Elema AB,Solna,Sweden) compliance 20 mL/cmH20, resistance 12 cmH20. We recorded PEEP, shape of curve, MIP & RR. Shape was classified: Deacelerant, if PEEP not maintained; OK, if PEEP maintained and keep plateau; and Keeping, PEEP remains without plateau Results: ASIB with 15 bpm generated a MIP of 30,87(±2,08) cmH2O and 23,6(±1,27) bpm. With 30 bpm, MIP 30,53(±3,04) cmH20 and 31,93(±5,89) bpm. PEEP generated were 1,88(±0,47) it was OK; 3,68(±0.02); 5,08(±0,459); 7,83(±0,14) and 9,73(±0,71) cmH20, deacelerant. With ASIBP, 15 bpm was 13,67(±1,87) bpm, MIP 31,07(0,67) cmH20. RR 30 bpm, 24,13(±1,93) bpm and MIP 31,67(±1,61) cmH20. PEEP obtained were 1,65(±0,4), OK; 4.03(± 0,66), deacelerant; 9,65(±1,49), OK; 13,3(±0,94) and 18,17(±1,04), deacelerant. With FIB, 15 bpm, RR was 20,27(±3,83) bpm, MIP 29,27(2,02) cmH20. RR of 30 bpm, RR 29,53(±2,47) bpm, MIP 30,2(±3,48) cmH20. PEEP was 1,35(±0,21); 4,03(±0,19); 9,8(±0,33); 14,82(±0,499) and 19,65(±0,21) cmH2O, all OK Conclusions: RR with MVS tends to be higher(reported). Training and manometer are essential. PEEP with ASIB is poorly maintained and no plateau, however, it can generate PEEP. ASIBP keeps stable PEEP values and a steady shape, but it shows typical mistake of over estimation.FIB maintains PEEP values with stable plateau, but at low RR has the risk of increase RR and the handling requires a longer training. Use of ASIBP or FIB are reliable to maintain PEEP. Clinical studies are need Sponsored Research - None