title: Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk?
abstract: OBJECTIVE
  When ventilating an unintubated patient in cardiac or respiratory arrest, smaller tidal volumes of 500 ml instead of 800-1200 ml may be beneficial to decrease peak airway pressure, and to minimise stomach inflation. The purpose was to determine the effects of small (approximately 500 ml) versus large (approximately 1000 ml) tidal volumes given with paediatric versus adult self-inflatable bags and approximately 50% oxygen on respiratory parameters in patients during simulated basic life support ventilation.
  
  
  METHODS
  While undergoing induction of anaesthesia, patients were randomised to three minutes of ventilation with either an adult (n = 40) or paediatric (n = 40) self-inflatable bag.
  
  
  RESULTS
  When compared with an adult self-inflatable bag, the paediatric bag resulted in significantly lower mean (+/- standard deviation) exhaled tidal volume (365 +/- 55 versus 779 +/- 122 ml; P < 0.0001), peak airway pressure (20 +/- 2 versus 25 +/- 5 cm H2O; P < 0.0001), but comparable oxygen saturation (97 +/- 1% versus 98 +/- 1%; NS (nonsignificant)). Stomach inflation occurred in five of 40 patients ventilated with an adult self-inflatable bag, but in no patients who were ventilated with a paediatric self-inflatable bag (P = 0.054).
  
  
  CONCLUSIONS
  Administering smaller tidal volumes with a paediatric instead of an adult self-inflatable bag in unintubated adult patients with respiratory arrest maintains good oxygenation and carbon dioxide elimination while decreasing peak airway pressure, which makes stomach inflation less likely.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, The Leopold-Franzens-University of Innsbruck, Austria. volker.wenzel@uibk.ac.at
authors.forename: V
authors.initials: V
authors.lastname: Wenzel
authors.forename: C
authors.initials: C
authors.lastname: Keller
authors.forename: A H
authors.initials: AH
authors.lastname: Idris
authors.forename: V
authors.initials: V
authors.lastname: Dörges
authors.forename: K H
authors.initials: KH
authors.lastname: Lindner
authors.forename: J R
authors.initials: JR
authors.lastname: Brimacombe
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D013990:Tidal Volume; D012122:Ventilators, Mechanical