Ventilation Laboratory (Vent'Lab), Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France; Med(2)Lab, Air Liquide Medical Systems, Antony, France.
Ventilation Laboratory (Vent'Lab), Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France; Emergency Department, Angers University Hospital, Angers, France.
Resuscitation. 2024 Jan;194:109999. doi: 10.1016/j.resuscitation.2023.109999. Epub 2023 Oct 12.
Bag-Valve-Device (BVD) is the most frequently used device for pre-oxygenation and ventilation during cardiopulmonary resuscitation (CPR). A minimal expired fraction of oxygen (FeO) above 0.85 is recommended during pre-oxygenation while insufflated volume (VTi) should be reduced during manual ventilation. The objective was to compare the performances of different BVD in simulated conditions.
Nine BVD were evaluated during pre-oxygenation: spontaneous breathing patients were simulated on a test lung (mild and severe conditions). FeO was measured with and without positive end-expiratory pressure (PEEP). CO rebreathing was evaluated. Then, manual ventilation was performed by 36 caregivers (n = 36) from three hospitals on a specific manikin; same procedure was repeated by 3 caregivers (n = 3) on two human cadavers with three of the nine BVD: In non-CPR scenario and during mechanical CPR with Interrupted Chest Compressions strategy (30:2).
Pre-oxygenation: FeO was lower than 0.85 for three BVD in severe condition and for two BVD in mild condition. FeO was higher than 0.85 in eight of nine BVD with an additional PEEP valve (PEEP 5 cmHO). One BVD induced CO rebreathing. Manual ventilation: For non-CPR manual ventilation, mean VTi was within the predefined lung protective range (4-8 mL/kg PBW) for all BVD on the bench. For CPR manual ventilation, mean VTi was above the range for three BVD on the bench. Similar results were observed on cadavers.
Several BVD did not reach the FeO required during pre-oxygenation. Manual ventilation was significantly less protective in three BVD. These observations are related to the different BVD working principles.
在心肺复苏（CPR）期间，球囊-面罩（BVD）是最常使用的预充氧和通气设备。推荐在预充氧期间使呼出末氧分数（FeO）最小化至 0.85 以上，同时应减少手动通气时的潮气量（VTi）。本研究旨在比较不同 BVD 在模拟条件下的性能。
在测试肺上模拟自主呼吸患者（轻度和重度条件），评估了 9 种 BVD 在预充氧期间的性能。分别测量有无呼气末正压通气（PEEP）时的 FeO。评估 CO 重吸入。然后，来自 3 家医院的 36 名护理人员（n=36）在专用模拟人上进行手动通气；同一位护理人员（n=3）在 2 具人体尸体上重复了 3 次，使用了 9 种 BVD 中的 3 种：非 CPR 场景和机械 CPR 期间采用中断胸外按压策略（30:2）。
预充氧：在重度条件下，有 3 种 BVD 的 FeO 低于 0.85，在轻度条件下，有 2 种 BVD 的 FeO 低于 0.85。在 9 种 BVD 中有 8 种，外加一个附加的呼气末正压通气阀（PEEP 5 cmH2O）时，FeO 高于 0.85。有一种 BVD 会引起 CO 重吸入。手动通气：对于非 CPR 手动通气，所有 BVD 在台面上的平均 VTi 均在预设的肺保护性范围内（4-8 mL/kg PBW）。对于 CPR 手动通气，在台面上有 3 种 BVD 的平均 VTi 超过了该范围。在尸体上也观察到了类似的结果。
几种 BVD 未达到预充氧期间所需的 FeO。在三种 BVD 中，手动通气的保护作用明显降低。这些观察结果与不同的 BVD 工作原理有关。
