Positive-pressure ventilation during transport: a randomized crossover study of self-inflating and flow-inflating resuscitators in a simulation model

• Published in: Pediatric anesthesia 2014-12, Vol.24 (12), p.1281-1287
• Main Authors: Lucy, Malcolm J., Gamble, Jonathan J., Daku, Brian L., Bryce, Rhonda D., Rana, Masud
• Format: Article
• Language: English
• Subjects: artificial; Cross-Over Studies; Environment Design; Equipment Design; Humans; intensive care; Intubation, Intratracheal; Lung - anatomy & histology; mechanical; Models, Anatomic; Positive-Pressure Respiration - instrumentation; pulmonary ventilation; respiration; resuscitation; transportation of patients; Transportation of Patients - methods; Treatment Outcome; ventilators
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.12461

Summary Background Positive‐pressure ventilation during transport of intubated patients is generally delivered via a hand‐pressurized device. Of these devices, self‐inflating resuscitators (SIR) and flow‐inflating resuscitators (FIR) constitute the two major types used. Selection of a particular device for transport, however, remains largely an institutional practice. Objective To evaluate the hypothesis that transport ventilation goals of intubated pediatric patients are better achieved using an FIR compared to an SIR. Methods This randomized crossover simulation study compared the performance of SIR and FIR among anesthesia providers in a pediatric transport scenario. Subjects hand‐ventilated a test lung while simultaneously maneuvering a stretcher bed to simulate patient transport. Hand ventilation was carried out using a Jackson–Rees circuit (FIR) and a Laerdal pediatric silicone resuscitator (SIR). The primary outcome was the proportion of total breaths delivered within the predefined target PIP/PEEP range (30+/− 3, 10+/− 3 cm H2O). Secondary outcomes included proportion of total breaths delivered with operationally defined unacceptable breath variables (PIP > 35 cm H2O or PEEP