title: The effects of different mouth-to-mouth ventilation tidal volumes on gas exchange during simulated rescue breathing.
abstract: The American Heart Association recommends tidal volumes of 700 to 1000 mL during mouth-to-mouth ventilation, but smaller tidal volumes of 500 mL may be of advantage to decrease the likelihood of stomach inflation. Because mouth-to-mouth ventilation gas contains only 17% oxygen, but 4% carbon dioxide, it is unknown whether 500-mL tidal volumes given during rescue breathing may result in insufficient oxygenation and inadequate carbon dioxide elimination. In a university hospital research laboratory, 20 fully conscious volunteer health care professionals were randomly assigned to breathe tidal volumes of 500 or 1000 mL of mouth-to-mouth ventilation gas (17% oxygen, 4% carbon dioxide, 79% nitrogen), or room air control (21% oxygen, 79% nitrogen) for 5 min. Arterial blood gases were taken immediately before, and after breathing 5 min of the experimental gas composition. When comparing 500 versus 1000 mL of mouth-to-mouth ventilation tidal volumes with 500 mL of room air, 500 mL of mouth-to-mouth ventilation tidal volume resulted in significantly (P < 0.05) lower mean +/- SEM arterial oxygen partial pressure (70 +/- 1 versus 85 +/- 2 versus 92 +/- 3 mm Hg, respectively), and lower oxygen saturation (94 +/- 0.4 versus 97 +/- 0.2 versus 98 +/- 0.2%), but increased arterial carbon dioxide partial pressure (46 +/- 1 versus 40 +/- 1 versus 39 +/- 1 mm Hg, respectively). Sixteen of 20 volunteers had to be excluded from the experiment with 500 mL of mouth-to-mouth ventilation gas after about 3 min instead of after 5 minutes as planned because of severe nervousness, sweating, and air hunger. We conclude that during simulated mouth-to-mouth ventilation, only large (approximately 1000 mL), but not small (approximately 500 mL) tidal volumes were able to maintain both sufficient oxygenation and adequate carbon dioxide elimination.
  
  
  CONCLUSIONS
  To provide efficient mouth-to-mouth ventilation, it is important to administer tidal volumes of 1000 mL; tidal volumes of 500 mL were not adequate.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria. Angelika.Stallinger@uibk.ac.at
authors.forename: A
authors.initials: A
authors.lastname: Stallinger
authors.forename: V
authors.initials: V
authors.lastname: Wenzel
authors.forename: S
authors.initials: S
authors.lastname: Oroszy
authors.forename: V D
authors.initials: VD
authors.lastname: Mayr
authors.forename: A H
authors.initials: AH
authors.lastname: Idris
authors.forename: K H
authors.initials: KH
authors.lastname: Lindner
authors.forename: C
authors.initials: C
authors.lastname: Hörmann
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D010298:Parity; D011897:Random Allocation; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen