Division of Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Pediatrics. 2011 Nov;128(5):e1195-200. doi: 10.1542/peds.2010-3696. Epub 2011 Oct 3.
To examine the hypothesis that pediatric resuscitation providers hyperventilate patients via bag-valve-mask (BVM) ventilation during performance of cardiopulmonary resuscitation (CPR), quantify the degree of excessive ventilation provided, and determine if this tendency varies according to provider type.
A retrospective, observational study was conducted of 72 unannounced, monthly simulated pediatric medical emergencies ("mock codes") in a tertiary care, academic pediatric hospital. Responders were code team members, including pediatric residents and interns (MDs), respiratory therapists (RTs), and nurses (RNs). All sessions were video-recorded and reviewed for the rate of BVM ventilation, rate of chest compressions, and the team members performing these tasks. The type of emergency, location of the code, and training level of the team leader were also recorded.
Hyperventilation was present in every mock code reviewed. The mean rate of BVM ventilation for all providers in all scenarios was 40.6 ± 11.8 breaths per minute (BPM). The mean ventilation rates for RNs, RTs, and MDs were 40.8 ± 14.7, 39.9 ± 11.7, and 40.5 ± 10.3 BPM, respectively, and did not differ among providers (P = .94). All rates were significantly higher than the recommended rate of 8 to 20 BPM (per Pediatric Advanced Life Support guidelines, varies with patient age) (P < .001). The mean ventilation rate in cases of isolated respiratory arrest was 44.0 ± 13.9 BPM and was not different from the mean BVM ventilation rate in cases of cardiopulmonary arrest (38.9 ± 14.4 BPM; P = .689).
Hyperventilation occurred in simulated pediatric resuscitation and did not vary according to provider type. Future educational interventions should focus on avoidance of excessive ventilation.
检验小儿复苏提供者在进行心肺复苏（CPR）时通过球囊面罩通气（BVM）过度通气的假设，量化提供的过度通气程度，并确定这种趋势是否根据提供者类型而变化。
对一家三级保健学术儿科医院进行了 72 次未经宣布的每月模拟儿科医疗紧急情况（“模拟代码”）的回顾性观察研究。响应者是代码团队成员，包括儿科住院医师和实习生（MD）、呼吸治疗师（RT）和护士（RN）。所有会议都进行了录像和审查，以评估 BVM 通气率、胸外按压率以及执行这些任务的团队成员。还记录了紧急情况的类型、代码的位置和团队负责人的培训水平。
在审查的每个模拟代码中都存在过度通气。所有场景中所有提供者的平均 BVM 通气率为 40.6 ± 11.8 次/分钟（BPM）。RN、RT 和 MD 的平均通气率分别为 40.8 ± 14.7、39.9 ± 11.7 和 40.5 ± 10.3 BPM，提供者之间无差异（P =.94）。所有速度均明显高于推荐的 8 至 20 BPM（根据儿科高级生命支持指南，随患者年龄而变化）（P <.001）。孤立性呼吸暂停病例的平均通气率为 44.0 ± 13.9 BPM，与心肺骤停病例的平均 BVM 通气率（38.9 ± 14.4 BPM）无差异（P =.689）。
在模拟小儿复苏中发生了过度通气，并且与提供者类型无关。未来的教育干预措施应侧重于避免过度通气。
