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CRITICAL CARE AND TRAUMA

Developing a Strategy to Improve Ventilation in an Unprotected Airway with a Modified Mouth-to-Bag Resuscitator in Apneic Patients

Department of Anesthesiology and Critical Care Medicine, Medical University, Innsbruck, Austria

Address correspondence and reprint requests to Dr. Achim von Goedecke, Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to achim.von-goedecke{at}uibk.ac.at

The strategies to ensure safety during ventilation of an unprotected airway are limiting airway pressure and/or inspiratory flow. In this prospective, randomized study we assessed the effect of face mask ventilation with small tidal volumes in the modified mouth-to-bag resuscitator (maximal volume, 500 mL) versus a pediatric self-inflatable bag versus automatic pressure-controlled ventilation in 40 adult apneic patients during induction of anesthesia. The mouth-to-bag resuscitator requires the rescuer to blow up a balloon inside the self-inflating bag that subsequently displaces air which then flows into the patient’s airway. Respiratory variables were measured with a pulmonary monitor (CP-100). Mouth-to-bag resuscitator and pressure-controlled ventilation resulted in significantly lower (mean ± SD) peak airway pressure (8 ± 2 and 8 ± 1 cm H₂O), peak inspiratory flow rate (0.7 ± 0.1 and 0.7 ± 0.1 L/s), and larger inspiratory time fraction (33% ± 5% and 47% ± 2%) in comparison to pediatric self-inflating bag ventilation (12 ± 3 cm H₂O; 1 ± 0.2 L/s; 27% ± 4%; all P < 0.001). The tidal volumes were similar between groups. No stomach inflation occurred in either group. We conclude that using a modified mouth-to-bag resuscitator or automatic pressure-controlled ventilation with similar small tidal volumes during face mask ventilation resulted in an approximately 25% reduction in peak airway pressure when compared with a standard pediatric self-inflating bag.

IMPLICATIONS: Using a modified mouth-to-bag resuscitator or automatic pressure-controlled ventilation during ventilation of an unprotected airway resulted in an approximately 25% reduction in peak flow rate and peak airway pressure when compared with a pediatric self-inflating bag.