Bag valve mask

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Bag valve mask
Ballon ventilation 1.jpg
A disposable BVM Resuscitator
Acronym BVM
Synonyms Ambu bag, manual resuscitator, self-inflating bag
Inventor(s)Holger Hesse, Henning Ruben
Invention date1953
Manufacturer Ambu

A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately. The device is a required part of resuscitation kits for trained professionals in out-of-hospital settings (such as ambulance crews) and is also frequently used in hospitals as part of standard equipment found on a crash cart, in emergency rooms or other critical care settings. Underscoring the frequency and prominence of BVM use in the United States, the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care recommend that "all healthcare providers should be familiar with the use of the bag-mask device." [1] Manual resuscitators are also used within the hospital for temporary ventilation of patients dependent on mechanical ventilators when the mechanical ventilator needs to be examined for possible malfunction or when ventilator-dependent patients are transported within the hospital. Two principal types of manual resuscitators exist; one version is self-filling with air, although additional oxygen (O2) can be added but is not necessary for the device to function. The other principal type of manual resuscitator (flow-inflation) is heavily used in non-emergency applications in the operating room to ventilate patients during anesthesia induction and recovery.[ citation needed ]

Contents

Use of manual resuscitators to ventilate a patient is frequently called "bagging" the patient [2] and is regularly necessary in medical emergencies when the patient's breathing is insufficient (respiratory failure) or has ceased completely (respiratory arrest). Use of the manual resuscitator force-feeds air or oxygen into the lungs in order to inflate them under pressure, thus constituting a means to manually provide positive-pressure ventilation. It is used by professional rescuers in preference to mouth-to-mouth ventilation, either directly or through an adjunct such as a pocket mask.

History

The bag valve mask concept was developed in 1956 by the German engineer Holger Hesse and his partner, Danish anaesthetist Henning Ruben, following their initial work on a suction pump. [3] Hesse's company was later renamed Ambu A/S, which has manufactured and marketed the device since 1956. An Ambu bag is a self-inflating bag resuscitator from Ambu A/S, which still manufactures and markets self-inflating bag resuscitators.[ citation needed ]

Today there are several manufacturers of self-inflating bag resuscitators. Some, like the original Ambu bag, are durable and intended for reuse after thorough cleaning. Others are inexpensive and intended for single patient use.[ citation needed ]

Initially produced in one size, BVMs are now available in sizes for use with infants, children or adults.[ citation needed ]

Standard components

Mask

Bag valve mask. Part 1 is the flexible mask to seal over the patients face, part 2 has a filter and valve to prevent backflow into the bag (prevents patient deprivation and bag contamination) and part 3 is the soft bag element which is squeezed to expel air to the patient Bag valve mask.jpg
Bag valve mask. Part 1 is the flexible mask to seal over the patients face, part 2 has a filter and valve to prevent backflow into the bag (prevents patient deprivation and bag contamination) and part 3 is the soft bag element which is squeezed to expel air to the patient

The BVM consists of a flexible air chamber (the "bag", roughly 30 cm in length), attached to a face mask via a shutter valve. When the face mask is properly applied and the "bag" is squeezed, the device forces air through into the patient's lungs; when the bag is released, it self-inflates from its other end, drawing in either ambient air or a low pressure oxygen flow supplied by a regulated cylinder, while also allowing the patient's lungs to deflate to the ambient environment (not the bag) past the one way valve.[ citation needed ]

Bag and valve

Bag and valve combinations can also be attached to an alternative airway adjunct, instead of to the mask. For example, it can be attached to an endotracheal tube or laryngeal mask airway. Small heat and moisture exchangers, or humidifying/bacterial filters, can be used.

A bag valve mask can be used without being attached to an oxygen tank to provide "room air" (21% oxygen) to the patient. However, manual resuscitator devices also can be connected to a separate bag reservoir, which can be filled with pure oxygen from a compressed oxygen source, thus increasing the amount of oxygen delivered to the patient to nearly 100%. [4]

Bag valve masks come in different sizes to fit infants, children, and adults. The face mask size may be independent of the bag size; for example, a single pediatric-sized bag might be used with different masks for multiple face sizes, or a pediatric mask might be used with an adult bag for patients with small faces.

Most types of the device are disposable and therefore single use, while others are designed to be cleaned and reused.

Method of operation

Operation of bag valve mask Resuscitator 3 - Operation (PSF).png
Operation of bag valve mask

Manual resuscitators cause the gas inside the inflatable bag portion to be force-fed to the patient via a one-way valve when compressed by the rescuer; the gas is then ideally delivered through a mask and into the patient's trachea, bronchus and into the lungs. In order to be effective, a bag valve mask must deliver between 500 and 600 milliliters of air to a normal male adult patient's lungs, but if supplemental oxygen is provided 400 ml may still be adequate. [2] Squeezing the bag once every 5 to 6 seconds for an adult or once every 3 seconds for an infant or child provides an adequate respiratory rate (10–12 respirations per minute in an adult and 20 per minute in a child or infant). [5]

Professional rescuers are taught to ensure that the mask portion of the BVM is properly sealed around the patient's face (that is, to ensure proper "mask seal"); otherwise, pressure needed to force-inflate the lungs is released to the environment. This is difficult when a single rescuer attempts to maintain a face mask seal with one hand while squeezing the bag with other. Therefore, common protocol uses two rescuers: one rescuer to hold the mask to the patient's face with both hands and focus entirely on maintaining a leak-proof mask seal, while the other rescuer squeezes the bag and focuses on breath (or tidal volume) and timing. [6]

An endotracheal tube (ET) can be inserted by an advanced practitioner and can substitute for the mask portion of the manual resuscitator. This provides more secure air passage between the resuscitator and the patient, since the ET tube is sealed with an inflatable cuff within the trachea (or windpipe), so any regurgitation is less likely to enter the lungs, and so that forced inflation pressure can only go into the lungs and not inadvertently go to the stomach (see "complications", below). The ET tube also maintains an open and secure airway at all times, even during CPR compressions; as opposed to when a manual resuscitator is used with a mask when a face mask seal can be difficult to maintain during compressions.[ citation needed ]

Bag valve masks used in combat

Airway obstruction is a leading cause of death in battlefield trauma. [7] Airway management in combat is very different from its civilian equivalent. In combat, maxillofacial trauma is the primary cause of airway obstruction. The injury is frequently complicated by a struggling patient, distorted anatomy, and blood, [8] and these injuries often have significant associated hemorrhage from accompanying vascular injuries. [9]

Military paramedics face extreme challenges, including "darkness, hostile fire, resource limitations, prolonged evacuation times, unique casualty transportation issues, command and tactical decisions affecting health care, hostile environments and provider experience levels". [10] They often have to treat multiple casualties using only the equipment they are carrying on their backs. Therefore, space is of primary importance and compact bag valve masks, such as a Pocket BVM, have been created to save valuable space in the emergency kit.

Complications

Under normal breathing, the lungs inflate under a slight vacuum when the chest wall muscles and diaphragm expand; this "pulls" the lungs open, causing air to enter the lungs to inflate under a gentle vacuum. However, when using a manual resuscitator, as with other methods of positive-pressure ventilation, the lungs are force-inflated with pressurized air or oxygen. This inherently leads to risk of various complications, many of which depend on whether the manual resuscitator is being used with a face mask or ET tube. Complications are related to over-inflating or over-pressurizing the patient, which can cause: (1) air to inflate the stomach (called gastric insufflation); (2) lung injury from over-stretching (called volutrauma); or (3) lung injury from over-pressurization (called barotrauma).

Stomach inflation / lung aspiration

When a face mask is used in conjunction with a manual resuscitator, the intent is for the force-delivered air or oxygen to inflate the lungs. However air entering the patient also has access to the stomach via the esophagus, which can inflate if the resuscitator is squeezed too hard (causing air flow that is too rapid for the lungs to absorb alone) or too much (causing excess air to divert to the stomach)." [11] Gastric inflation can lead to vomiting and subsequent aspiration of stomach contents into the lungs, which has been cited as a major hazard of bag-valve-mask ventilation, [12] with one study suggesting this effect is difficult to avoid even for the most skilled and experienced users, stating "When using a self-inflatable bag, even experienced anesthesiologists in our study may have performed ventilation with too short inspiratory times or too large tidal volumes, which resulted in stomach inflation in some cases." [11] The study goes on to state that "Stomach inflation is a complex problem that may cause regurgitation, [gastric acid] aspiration, and, possibly, death." When stomach inflation leads to vomiting of highly acidic stomach acids, delivery of subsequent breaths can force these caustic acids down into the lungs where they cause life-threatening or fatal lung injuries including Mendelson's syndrome, aspiration pneumonia, acute respiratory distress syndrome and "pulmonary injuries similar to that seen in victims of chlorine gas exposure". [11] Apart from the risks of gastric inflation causing vomiting and regurgitation, at least two reports have been found indicating that gastric insufflation remains clinically problematic even when vomiting does not occur. In one case of failed resuscitation (leading to death), gastric insufflation in a 3-month-old boy put sufficient pressure against the lungs that "precluded effective ventilation". [13] Another reported complication was a case of stomach rupture caused by stomach over-inflation from a manual resuscitator. [14] The causative factors and degree of risk of inadvertent stomach inflation have been examined, [12] [15] with one published study revealing that during prolonged resuscitation up to 75% of air delivered to the patient may inadvertently be delivered to the stomach instead of the lungs. [15]

Lung injury and air embolism

When an endotracheal tube (ET) is placed, one of the key advantages is that a direct air-tight passageway is provided from the output of the manual resuscitator to the lungs, thus eliminating the possibilities of inadvertent stomach inflation or lung injuries from gastric acid aspiration. However this places the lungs at increased risk from separate lung injury patterns caused by accidental forced over-inflation (called volutrauma or barotrauma). Sponge-like lung tissue is delicate, and over-stretching can lead to acute respiratory distress syndrome – a condition that requires prolonged mechanical ventilator support in the ICU and is associated with poor survival (e.g., 50%), and significantly increased care costs of up to $30,000 per day. [16] Lung volutrauma, which can be caused by "careful" delivery of large, slow breaths, can also lead to a "popped" or collapsed lung (called a pneumothorax), with at least one published report describing "a patient in whom a sudden tension pneumothorax developed during ventilation with a bag-valve device." [17] Additionally, there is at least one report of manual resuscitator use where the lungs were accidentally over-inflated to the point where "the heart contained a large volume of air," and the "aorta and pulmonary arteries were filled with air" – a condition called an air embolism which "is almost uniformly fatal". However, the case was of a 95-year-old woman, as the authors point out that this type of complication has previously only been reported in premature infants. [18]

Public health risk from manual resuscitator complications

Two factors appear to make the public particularly at risk from complications from manual resuscitators: (1) their prevalence of use (leading to high probability of exposure), and (2) apparent inability for providers to protect patients from uncontrolled, inadvertent, forced over-inflation.

Prevalence of manual resuscitator use

Manual resuscitators are commonly used for temporary ventilation support, especially flow-inflation versions that are used during anesthesia induction/recovery during routine surgery. Accordingly, most citizens are likely to be "bagged" at least once during their lifetime as they undergo procedures involving general anesthesia. Additionally, a significant number of newborns are ventilated with infant-sized manual resuscitators to help stimulate normal breathing, making manual resuscitators among the first therapeutic medical devices encountered upon birth. As previously stated, manual resuscitators are the first-line device recommended for emergency artificial ventilation of critical care patients, and are thus used not only throughout hospitals but also in out-of-hospital care venues by firefighters, paramedics and outpatient clinic personnel.

Inability of professional providers to use manual resuscitators within established safety guidelines

Manual resuscitators have no built-in tidal volume control — the amount of air used to force-inflate the lungs during each breath depends entirely on how much the operator squeezes the bag. In response to the dangers associated with the use of manual resuscitators, specific guidelines from the American Heart Association [1] and European Resuscitation Council [19] were issued that specify recommended maximal tidal volumes (or breath sizes) and ventilation rates safe for patients. While no studies are known that have assessed the frequency of complications or deaths due to uncontrolled manual resuscitator use, numerous peer-reviewed studies have found that, despite established safety guidelines, the incidence of provider over-inflation with manual resuscitators continues to be "endemic" [20] and unrelated to provider training or skill level. Another clinical study found "the tidal volume delivered by a manual resuscitator shows large variations", concluding that "the manual resuscitator is not a suitable device for accurate ventilation." [21] A separate assessment of another high-skilled group with frequent emergency use of manual resuscitators (ambulance paramedics) found that "Despite seemingly adequate training, EMS personnel consistently hyperventilated patients during out-of-hospital CPR", with the same research group concluding that "Unrecognized and inadvertent hyperventilation may be contributing to the currently dismal survival rates from cardiac arrest." [20] A peer-reviewed study published in 2012 assessed the possible incidence of uncontrolled over-inflation in newborn neonates, finding that "a large discrepancy between the delivered and the current guideline values was observed for all parameters," and that "regardless of profession or handling technique ... 88.4% delivered excessive pressures, whereas ... 73.8% exceeded the recommended range of volume", concluding that "the great majority of research group concluding that "Unrecognized and inadvertent hyperventilation from all professional groups delivered excessive pressures and volumes." [22] A further examination has recently been made to assess whether a solution to the over-ventilation problem may lie with the use of pediatric-sized manual resuscitators in adults or use of more advanced flow-inflation (or "Mapleson C") versions of manual resuscitators: while "the paediatric self-inflating bag delivered the most guideline-consistent ventilation", it did not lead to full guideline compliance as "participants hyperventilated patients' lungs in simulated cardiac arrest with all three devices." [23]

Guideline non-compliance due to excessive rate versus excessive lung inflation

"Hyperventilation" can be achieved through delivery of (1) too many breaths per minute; (2) breaths that are too large and exceed the patient's natural lung capacity; or (3) a combination of both. With use of manual resuscitators, neither rate nor inflating volumes can be physically controlled through built-in safety adjustments within the device, and as highlighted above, studies show providers frequently exceed designated safety guidelines for both ventilation rate (10 breaths per minute) and volume (5–7 mL/kg body weight) as outlined by the American Heart Association [1] and European Resuscitation Council. [19] Numerous studies have concluded that ventilation at rates in excess of current guidelines are capable of interfering with blood flow during cardiopulmonary resuscitation, however the pre-clinical experiments associated with these findings involved delivery of inspiratory volumes in excess of current guidelines, e.g., they assessed the effects of hyperventilation via both excessive rate and excessive volumes simultaneously. [20] [24] A more recent study published in 2012 expanded knowledge on this topic by evaluating the separate effects of (1) isolated excessive rate with guideline-compliant inspiratory volumes; (2) guideline-compliant rate with excessive inspiratory volumes; and (3) combined guideline non-compliance with both excessive rate and volume. [25] This study found that excessive rate more than triple the current guideline (e.g., 33 breaths per minute) may not interfere with CPR when inspiratory volumes are delivered within guideline-compliant levels, suggesting that ability to keep breath sizes within guideline limits may individually mitigate clinical dangers of excessive rate. [25] It was also found that when guideline-excessive tidal volumes were delivered, changes in blood flow were observed that were transient at low ventilation rates but sustained when both tidal volumes and rates were simultaneously excessive, suggesting that guideline-excessive tidal volume is the principal mechanism of side effects, with ventilation rate acting as a multiplier of these effects. [25] Consistent with previous studies where both excessive rate and volumes were found to produce side effects of blood flow interference during CPR, [20] [24] a complicating factor may be inadequate time to permit full expiration of oversized breaths in between closely spaced high-rate breaths, leading to the lungs never being permitted to fully exhale between ventilations (also called "stacking" of breaths). [25] A recent advancement in the safety of manual ventilation may be the growing use of time-assist devices that emit an audible or visual metronome tone or flashing light at the proper guideline-designated rate interval for breath frequency; one study found these devices may lead to near 100% guideline compliance for ventilation rate. [26] While this advancement appears to provide a solution to the "rate problem" associated with guideline-excessive manual resuscitator use, it may not address the "volume problem", which may continue to make manual resuscitators a patient hazard, as complications can still occur from over-inflation even when rate is delivered within guidelines.

Currently,[ when? ] the only devices that can deliver pre-set, physician-prescribed inflation volumes reliably within safety guidelines are mechanical ventilators that require an electrical power source or a source of compressed oxygen, a higher level of training to operate, and typically cost hundreds to thousands of dollars more than a disposable manual resuscitator.

Additional components and features

Filters

A filter is sometimes placed between the mask and the bag (before or after the valve) to prevent contamination of the bag.

Positive end-expiratory pressure

Some devices have PEEP valve connectors, for better positive airway pressure maintenance.

Medication delivery

A covered port may be incorporated into the valve assembly to allow inhalatory medicines to be injected into the airflow, which may be particularly effective in treating patients in respiratory arrest from severe asthma.

Airway pressure port

A separate covered port may be included into the valve assembly to enable a pressure-monitoring device to be attached, enabling rescuers to continuously monitor the amount of positive-pressure being generated during forced lung inflation.

Pressure relief valves

A pressure relief valve (often known as a "pop-up valve") is typically included in pediatric versions and some adult versions, the purpose of which is to prevent accidental over-pressurization of the lungs. A bypass clip is usually incorporated into this valve assembly in case medical needs call for inflation at a pressure beyond the normal cutoff of the pop-up valve.

Device storage features

Some bags are designed to collapse for storage. A bag not designed to store collapsed may lose elasticity when stored compressed for long periods, reducing its effectiveness. The collapsible design has longitudinal scoring so that the bag collapses on the scoring "pivot point," opposite to the direction of normal bag compression.

Manual resuscitator alternatives

In a hospital, long-term mechanical ventilation is provided by using a more complex, automated ventilator. However, a frequent use of a manual resuscitator is to temporarily provide manual ventilation whenever troubleshooting of the mechanical ventilator is needed, if the ventilator circuit needs to be changed, or if there is a loss of electrical power or source of compressed air or oxygen.A rudimentary type of mechanical ventilator device that has the advantage of not needing electricity is a flow-restricted, oxygen-powered ventilation device (FROPVD). These are similar to manual resuscitators in that oxygen is pushed through a mask to force-inflate the patient's lungs, but unlike a manual resuscitator where the pressure used to force-inflate the patient's lungs comes from a person manually squeezing a bag, with the FROPVD the pressure needed to force-inflate the lungs comes directly from a pressurized oxygen cylinder. These devices will stop functioning when the compressed oxygen tank becomes depleted.[ citation needed ]

Types of manual resuscitators

See also

Related Research Articles

<span class="mw-page-title-main">Mouth-to-mouth resuscitation</span> Artificial ventilation using exhaled air from the rescuer

Mouth-to-mouth resuscitation, a form of artificial ventilation, is the act of assisting or stimulating respiration in which a rescuer presses their mouth against that of the victim and blows air into the person's lungs. Artificial respiration takes many forms, but generally entails providing air for a person who is not breathing or is not making sufficient respiratory effort on their own. It is used on a patient with a beating heart or as part of cardiopulmonary resuscitation (CPR) to achieve the internal respiration.

<span class="mw-page-title-main">Ventilator</span> Device that provides mechanical ventilation to the lungs

A ventilator is a type of breathing apparatus, a class of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators may be computerized microprocessor-controlled machines, but patients can also be ventilated with a simple, hand-operated bag valve mask. Ventilators are chiefly used in intensive-care medicine, home care, and emergency medicine and in anesthesiology.

<span class="mw-page-title-main">Mechanical ventilation</span> Method to mechanically assist or replace spontaneous breathing

Mechanical ventilation or assisted ventilation is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, with the main goal of helping the delivery of oxygen and removal of carbon dioxide. Mechanical ventilation is used for many reasons, including to protect the airway due to mechanical or neurologic cause, to ensure adequate oxygenation, or to remove excess carbon dioxide from the lungs. Various healthcare providers are involved with the use of mechanical ventilation and people who require ventilators are typically monitored in an intensive care unit.

<span class="mw-page-title-main">Positive airway pressure</span> Mechanical ventilation in which airway pressure is always above atmospheric pressure

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco. A variation of the PAP system was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.

<span class="mw-page-title-main">Anaesthetic machine</span> Medical device to supply a mix of life-support and anaesthetic gases

An anaesthetic machine or anesthesia machine is a medical device used to generate and mix a fresh gas flow of medical gases and inhalational anaesthetic agents for the purpose of inducing and maintaining anaesthesia.

<span class="mw-page-title-main">Laryngeal mask airway</span> Medical device for maintaining an open airway

A laryngeal mask airway (LMA), also known as laryngeal mask, is a medical device that keeps a patient's airway open during anaesthesia or while they are unconscious. It is a type of supraglottic airway device. They are most commonly used by anaesthetists to channel oxygen or inhalational anaesthetic to the lungs during surgery and in the pre-hospital setting for unconscious patients.

<span class="mw-page-title-main">Airway management</span> Medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

<span class="mw-page-title-main">Respiratory arrest</span> Medical condition

Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body. Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may permanently damage vital organs, especially the brain. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes.

<span class="mw-page-title-main">Artificial ventilation</span> Assisted breathing to support life

Artificial ventilation is a means of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration. It may take the form of manually providing air for a person who is not breathing or is not making sufficient respiratory effort, or it may be mechanical ventilation involving the use of a mechanical ventilator to move air in and out of the lungs when an individual is unable to breathe on their own, for example during surgery with general anesthesia or when an individual is in a coma or trauma.

A resuscitator is a device using positive pressure to inflate the lungs of an unconscious person who is not breathing, in order to keep them oxygenated and alive. There are three basic types: a manual version consisting of a mask and a large hand-squeezed plastic bulb using ambient air, or with supplemental oxygen from a high-pressure tank. The second type is the expired air or breath powered resuscitator. The third type is an oxygen powered resuscitator. These are driven by pressurized gas delivered by a regulator, and can either be automatic or manually controlled. The most popular type of gas powered resuscitator are time cycled, volume constant ventilators. In the early days of pre-hospital emergency services, pressure cycled devices like the Pulmotor were popular but yielded less than satisfactory results. Most modern resuscitators are designed to allow the patient to breathe on his own should he recover the ability to do so. All resuscitation devices should be able to deliver more than 85% oxygen when a gas source is available.

<span class="mw-page-title-main">Breathing apparatus</span> Equipment allowing or assisting the user to breath in a hostile environment

A breathing apparatus or breathing set is equipment which allows a person to breathe in a hostile environment where breathing would otherwise be impossible, difficult, harmful, or hazardous, or assists a person to breathe. A respirator, medical ventilator, or resuscitator may also be considered to be breathing apparatus. Equipment that supplies or recycles breathing gas other than ambient air in a space used by several people is usually referred to as being part of a life-support system, and a life-support system for one person may include breathing apparatus, when the breathing gas is specifically supplied to the user rather than to the enclosure in which the user is the occupant.

High-frequency ventilation is a type of mechanical ventilation which utilizes a respiratory rate greater than four times the normal value and very small tidal volumes. High frequency ventilation is thought to reduce ventilator-associated lung injury (VALI), especially in the context of ARDS and acute lung injury. This is commonly referred to as lung protective ventilation. There are different types of high-frequency ventilation. Each type has its own unique advantages and disadvantages. The types of HFV are characterized by the delivery system and the type of exhalation phase.

<span class="mw-page-title-main">Pocket mask</span> Device used to safely deliver first aid rescue breaths

A pocket mask, pocket face mask, or CPR mask is a device used to safely deliver rescue breaths during a cardiac arrest or respiratory arrest. The specific term "Pocket Mask" is the trademarked name for the product manufactured by Laerdal Medical AS. It is not to be confused with a bag valve mask (BVM).

<span class="mw-page-title-main">Non-rebreather mask</span> Device used for emergency oxygen therapy

A non-rebreather mask is a device used in medicine to assist in the delivery of oxygen therapy. A NRB requires that the patient can breathe unassisted, but unlike a low-flow nasal cannula, the NRB allows for the delivery of higher concentrations of oxygen. An ideal non-rebreather mask does not permit air from the surrounding environment to be inhaled, hence an event of a source gas failure is life-threatening.

A flow-restricted, oxygen-powered ventilation device (FROPVD), also referred to as a manually triggered ventilation device (MTV), is used to assist ventilation in apneic or hypoventilating patients, although these devices can also be used to provide supplemental oxygen to breathing patients. It can be used on patients with spontaneous breaths, as there is a valve that opens automatically on inspiration. When ventilating a patient with a (FROPVD) you must ensure an adequate, constant oxygen supply is available. Once the oxygen source is depleted, the device can no longer be used because it is driven completely by an oxygen source. The (FROPVD) has a peak flow rate of 100% oxygen at up to 40 liters per minute. To use the device, manually trigger it until chest rise is noted and then release. Wait five seconds before repeating. The device must have a pressure relief valve that opens at 60cm of water pressure to avoid over ventilation and trauma to the lungs. The (FROPVD) is contraindicated in adult patients with potential chest trauma and all children. Note: Proper training and considerable practice is required to correctly use the FROPVD devices.

<span class="mw-page-title-main">Orinasal mask</span> Breathing mask that covers the mouth and the nose only.

An orinasal mask, oro-nasal mask or oral-nasal mask is a breathing mask that covers the mouth and the nose only. It may be a complete independent item, as an oxygen mask, or on some anaesthetic apparatuses, or it may be fitted as a component inside a fullface mask on underwater breathing apparatus, a gas mask or an industrial respirator to reduce the amount of dead space. It may be designed for its lower edge to seal on the front of the lower jaw or to go under the chin.

Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional preferences, since there is a paucity of evidence indicating that the mode affects clinical outcome. The most frequently used forms of volume-limited mechanical ventilation are intermittent mandatory ventilation (IMV) and continuous mandatory ventilation (CMV). There have been substantial changes in the nomenclature of mechanical ventilation over the years, but more recently it has become standardized by many respirology and pulmonology groups. Writing a mode is most proper in all capital letters with a dash between the control variable and the strategy.

<span class="mw-page-title-main">Neonatal resuscitation</span>

Neonatal resuscitation, also known as newborn resuscitation, is an emergency procedure focused on supporting approximately 10% of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death. Many of the infants who require this support to start breathing breath well on their own after assistance. Through positive airway pressure, and in severe cases chest compressions, medical personnel certified in neonatal resuscitation can often stimulate neonates to begin breathing on their own, with attendant normalization of heart rate.

A negative pressure ventilator (NPV) is a type of mechanical ventilator that stimulates an ill person's breathing by periodically applying negative air pressure to their body to expand and contract the chest cavity.

<span class="mw-page-title-main">Glossary of breathing apparatus terminology</span> Definitions of technical terms used in connection with breathing apparatus

A breathing apparatus or breathing set is equipment which allows a person to breathe in a hostile environment where breathing would otherwise be impossible, difficult, harmful, or hazardous, or assists a person to breathe. A respirator, medical ventilator, or resuscitator may also be considered to be breathing apparatus. Equipment that supplies or recycles breathing gas other than ambient air in a space used by several people is usually referred to as being part of a life-support system, and a life-support system for one person may include breathing apparatus, when the breathing gas is specifically supplied to the user rather than to the enclosure in which the user is the occupant.

References

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  3. ↑ "Ambu's history". Ambu Ltd. Archived from the original on 2011-04-27.
  4. ↑ Stoy, Walt (2004). Mosby's EMT-Basic Textbook (PDF). Mosby/JEMS. ISBN   978-0-323-03438-8.
  5. ↑ Emergency Care, Pages 142–3
  6. ↑ Emergency Care, Page 141.
  7. ↑ Bell, David G.; McCann, Edward T.; Ferraro, David M. (2017-09-01). "Airway Management in Combat Trauma". Current Pulmonology Reports. 6 (3): 206–213. doi:10.1007/s13665-017-0186-8. ISSN   2199-2428. S2CID   79775969.
  8. ↑ daveairways (2013-07-03). "Airway management in a combat zone". Dave on Airways. Retrieved 2018-12-16.
  9. ↑ Mabry, Robert L.; Frankfurt, Alan (2011). "Advanced airway management in combat casualties by medics at the point of injury: a sub-group analysis of the reach study". Journal of Special Operations Medicine. 11 (2): 16–19. doi:10.55460/W35F-54HG. ISSN   1553-9768. PMID   21706457. S2CID   19536764.
  10. ↑ "Current and future combat airway options available to the Advanced Medical Assistant (AMA)". jmvh.org. Retrieved 2018-12-16.
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  13. ↑ Berg MD, Idris AH, Berg RA. Severe ventilatory compromise due to gastric insufflation during pediatric cardiopulmonary resuscitation. Resuscitation 1998: 36:71–73.
  14. ↑ Smally AJ, Ross MJ, Huot CP. Gastric rupture following bag-valve-mask ventilation. J Amer Med 2002: 22:27–29.
  15. 1 2 Wenzel V, Idris AH, Banner MJ, Kubilis PS, Williams JL Jr. Influence of tidal volume on the distribution of gas between the lungs and the stomach in the nonintubated patient receiving positive-pressure ventilation. Critical Care Medicine 1998: 26:364–368.
  16. ↑ Dasta JF, McLaughlin TP, Mody SH, Tak Piech C. Daily cost of an intensive care unit stay: The contribution of mechanical ventilation. Critical Care Medicine 2005: 33:1266–1271.
  17. ↑ Silbergleit R, Lee DC, Blank-Ried C, McNamara RM. Sudden severe barotrauma from self-inflating bag devices. Journal of Trauma 1996: 40:320–322.
  18. ↑ Kane G, Hewines B, Grannis FW Jr. Massive air embolism in an adult following positive pressure ventilation. Chest 1988: 93:874–876.
  19. 1 2 Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD. European Resuscitation Council Guidelines for Resuscitation 2010. Section 4. Adult advanced life support. Resuscitation 2010 :81:1305–1352.
  20. 1 2 3 4 research group concluding that "Unrecognized and inadvertent hyperventilation TP, Sigurdsson G, Pirrallo RG, Yannopoulos D, McKnite S, von Briesen C, Sparks CW, Conrad CJ, Provo TA, research group concluding that "Unrecognized and inadvertent hyperventilation KG. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 2004: 109:1960–1965.
  21. ↑ Lee HM, Cho KH, Choi YH, Yoon SY, Choi YH. Can you deliver accurate tidal volume by manual resuscitator. Emergency Medicine Journal 2008: 10:632–634.
  22. ↑ Bassani MA, Filho FM, de Carvalho Coppo MR, Marba STM. An evaluation of peak inspiratory pressure, tidal volume, and ventilatory frequency during ventilation with a neonatal self-inflating bag resuscitator. Respiratory Care 2012: 57:525–530.
  23. ↑ Sherren PB, Lewinsohn A, Jovaisa T, Wijayatilake DS. Comparison of the Mapleson C system and adult and paediatric self-inflating bags for delivering guideline-consistent ventilation during simulated adult cardiopulmonary resuscitation. Anaesthesia 2011 :66(7):563–567.
  24. 1 2 Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Critical Care Medicine 2004; 32(9 Suppl):S345–S351.
  25. 1 2 3 4 Gazmuri RJ, Ayoub IM, Radhakrishnan J, Motl J, Upadhyaya MP. Clinically plausible hyperventilation does not exert adverse hemodynamic effects during CPR but markedly reduces end-tidal PCO2. Resuscitation 2012; 83(2):259–264.
  26. ↑ Kern KB, Stickney RE, Gallison L, Smith RE. Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial. Resuscitation 2010:81(2):206-210.
  27. ↑ Anitha GF, Velmurugan L, Sangareddi S, Nedunchelian K, Selvaraj V (1 August 2016). "Effectiveness of flow inflating device in providing Continuous Positive Airway Pressure for critically ill children in limited-resource settings: A prospective observational study". Indian Journal of Critical Care Medicine. 20 (8): 441–447. doi: 10.4103/0972-5229.188171 . PMC   4994122 . PMID   27630454.
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