title: Evaluation of manual and automatic manually triggered ventilation performance and ergonomics using a simulation model.
abstract: BACKGROUND
  In the absence of endotracheal intubation, the manual bag-valve-mask (BVM) is the most frequently used ventilation technique during resuscitation. The efficiency of other devices has been poorly studied. The bench-test study described here was designed to evaluate the effectiveness of an automatic, manually triggered system, and to compare it with manual BVM ventilation.
  
  
  METHODS
  A respiratory system bench model was assembled using a lung simulator connected to a manikin to simulate a patient with unprotected airways. Fifty health-care providers from different professional groups (emergency physicians, residents, advanced paramedics, nurses, and paramedics; n = 10 per group) evaluated manual BVM ventilation, and compared it with an automatic manually triggered device (EasyCPR). Three pathological situations were simulated (restrictive, obstructive, normal). Standard ventilation parameters were recorded; the ergonomics of the system were assessed by the health-care professionals using a standard numerical scale once the recordings were completed.
  
  
  RESULTS
  The tidal volume fell within the standard range (400-600 mL) for 25.6% of breaths (0.6-45 breaths) using manual BVM ventilation, and for 28.6% of breaths (0.3-80 breaths) using the automatic manually triggered device (EasyCPR) (P < .0002). Peak inspiratory airway pressure was lower using the automatic manually triggered device (EasyCPR) (10.6 ± 5 vs 15.9 ± 10 cm H2O, P < .001). The ventilation rate fell consistently within the guidelines, in the case of the automatic manually triggered device (EasyCPR) only (10.3 ± 2 vs 17.6 ± 6, P < .001). Significant pulmonary overdistention was observed when using the manual BVM device during the normal and obstructive sequences. The nurses and paramedics considered the ergonomics of the automatic manually triggered device (EasyCPR) to be better than those of the manual device.
  
  
  CONCLUSIONS
  The use of an automatic manually triggered device may improve ventilation efficiency and decrease the risk of pulmonary overdistention, while decreasing the ventilation rate.
authors.affiliation: Emergency Department, Pôle Arsibou, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Marjanovic
authors.forename: Soizig
authors.initials: S
authors.lastname: Le Floch
authors.forename: Morgan
authors.initials: M
authors.lastname: Jaffrelot
authors.forename: Erwan
authors.initials: E
authors.lastname: L'Her
mesh_terms: D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D006804:Ergonomics; D006801:Humans; D007384:Intermittent Positive-Pressure Breathing / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008348:Manikins; D012115:Residual Volume; D056152:Respiratory Rate; D013990:Tidal Volume
keywords: automated system; bag-valve-mask; ergonomy; manual ventilation; performance evaluation; simulation