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TECHNOLOGY, COMPUTING, AND SIMULATION

An Audible Indication of Exhalation Increases Delivered Tidal Volume During Bag Valve Mask Ventilation of a Patient Simulator

Departments of Anesthesiology and Neurosurgery, University of Florida College of Medicine and the Departments of Mechanical and Aerospace Engineering and Electrical and Computer Engineering, University of Florida College of Engineering, Gainesville, Florida

Address correspondence and reprint requests to Samsun Lampotang, PhD, Department of Anesthesiology, PO Box 100254, Gainesville, FL 32610–0254. Address e-mail to slampotang{at}anest.ufl.edu.

Self-inflating manual resuscitators (SIMRs) can mislead caregivers because the bag, unlike a Mapleson-type device, reinflates even without patient exhalation. We added a whistle as an audible indicator to the exhalation port of a SIMR. In randomized order, each participant provided two sets of breaths via mask ventilation with a SIMR, one with and one without audible feedback, to a Human Patient Simulator modified to log lung volume changes. The last three breaths in each set were used to compare average tidal volume (Vt) under both conditions. Eighty-seven advanced cardiac life support trainees (54 males, 33 females) with clinical experience averaging 6.4 ± 9.4 yr were recruited. Average Vt delivered with the standard SIMR was 486 ± 166 mL and 624 ± 96 mL with the modified SIMR. Average Vt delivered by a modified SIMR was significantly larger by 40% when it followed standard SIMR use and 19% when using the modified SIMR first. Use of a SIMR with an audible indicator of exhalation significantly (P < 0.001) increased mask ventilation of a patient simulator, suggesting that mask ventilation of a patient with a SIMR may also be increased by objective, real-time feedback of exhaled Vt.

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