Ventilator-delivered mask ventilation compared with three standard methods of mask ventilation in a manikin model
- M B Tracy1,2,
- J Klimek1,2,
- H Coughtrey1,2,
- V Shingde1,2,
- G Ponnampalam1,
- M Hinder1,
- R Maheshwari1,
- S K Tracy2,3
- 1Department of Neonatology, Nepean Hospital Sydney West Area Health Service, Sydney, Australia
- 2University of Sydney, Sydney, Australia
- 3Royal Hospital for Women, Ranwick and Sydney University, Sydney, Australia
- Correspondence to Dr Mark Tracy, Department of Neonatology, Nepean Neonatal Intensive Care Unit, Nepean Hospital SWAHS, Derby Street Kingswood 2747, Sydney, Australia;
- Accepted 8 February 2010
- Published Online First 7 June 2010
Background Little is known regarding the variations in effective ventilation during bag and mask resuscitation with standard methods compared with that delivered by ventilator-delivered mask ventilation (VDMV).
Aim To measure the variations in delivered airway pressure, tidal volume (TV), minute ventilation (MV) and inspiratory time during a 3-min period of mask ventilation comparing VDMV with three commonly used hand-delivered methods of bag and mask ventilation: Laerdal self-inflating bag (SIB); anaesthetic bag and T-piece Neopuff.
Methods A modified resuscitation manikin was used to measure variation in mechanical ventilation during 3-min periods of mask ventilation. Thirty-six experienced practitioners gave positive pressure mask ventilation targeting acceptable chest wall movement with a rate of 60 inflations/min and when pressures could be targeted or set, a peak inspiratory pressure (PIP) of 18 cm water, positive end-expiratory pressure (PEEP) of 5 cm water, for 3 min with each of the four mask ventilation methods. Each mode was randomly sequenced.
Results A total of 21 136 inflations were recorded and analysed. VDMV achieved PIP and PEEP closest to that targeted and significantly lower variation in all measured parameters (p<0.001) other than with PIP. SIB delivered TV and MV over twice that delivered by VDMV and Neopuff.
Conclusion During 3-min periods of mask ventilation on a manikin, VDMV produced the least variation in delivered ventilation. SIB produced wide variation and unacceptably high TV and MV in experienced hands.
Competing interests None.
Ethics approval This study was conducted with the approval of the Human Research and Ethics Committee Sydney West Area Health Service, Nepean Campus.
Provenance and peer review Not commissioned; externally peer reviewed.