Smart Bag vs. Standard bag in the temporary substitution of the mechanical ventilation

• Published in: Intensive care medicine 2008-02, Vol.34 (2), p.355-360
• Main Authors: Lovat, Robin, Watremez, Christine, Van Dyck, Michel, Van Caenegem, Olivier, Verschuren, Franck, Hantson, Philippe, Jacquet, Luc-Marie
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Brief Report; Critical Care Medicine; Cross-Over Studies; Emergency and intensive respiratory care; Emergency Medicine; Female; Humans; Intensive; Intensive care medicine; Male; Masks; Medical sciences; Medicine; Medicine & Public Health; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Respiration, Artificial - instrumentation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-007-0850-5

Objective To compare in intubated patients manually ventilated in order to mirror the ventilator, the respiratory and hemodynamic effects induced by a bag device equipped with an inspiratory gas flow-limiting valve (Smart Bag, 0-Two Medical Technologies Inc., Mississauga, ON, Canada) and a Standard bag. Design Non-randomized crossover study comparing 13 respiratory and eight hemodynamically paired parameters. Eight intubated patients were manually ventilated, each by three different intensive care workers yielding 24 sets of data for comparison. Data were collected during two sessions of manual ventilation, first with the Standard bag and then with the Smart Bag. Between each session, the patient was reconnected to the ventilator until return to the baseline. Patients, included after coronary surgery, were sedated and paralyzed. Setting Intensive Care Unit, university hospital. Results Compared with Standard bag, the Smart Bag ® provided a decrease of inspiratory flow (23 ± 4.7 vs. 47.3 ± 16.5 l/min) with a decrease of peak pressure (13.3 ± 2.9 vs. 21.9 ± 7.3 cmH 2 O) and tidal volume (9.4 ± 2.8 vs. 12.4 ± 2.7 ml/kg). While the expiratory time was similar, the inspiratory time increased (1.83 ± 0.58 vs. 1.28 ± 0.46 s) with the Smart Bag, limiting the respiratory rate (14 ± 5 vs. 17 ± 6 cycles/min) and the minute volume (8.8 ± 2.9 vs. 14.4 ± 4.9 l/min). Finally, it limited the fall of the ETCO 2 (27.9 ± 5.1 vs. 24.3 ± 5.7 mmHg) and probably the risks of severe respiratory alkalosis. The bags similarly affected hemodynamic states. Conclusion In intubated patients manually ventilated, the Smart Bag limits the risks of excessive airway pressure and the fall of the ETCO 2 , with hemodynamic effects similar to those of the Standard bag.