title: Positive-pressure ventilation during transport: a randomized crossover study of self-inflating and flow-inflating resuscitators in a simulation model.
abstract: BACKGROUND
  Positive-pressure ventilation during transport of intubated patients is generally delivered via a hand-pressurized device. Of these devices, self-inflating resuscitators (SIR) and flow-inflating resuscitators (FIR) constitute the two major types used. Selection of a particular device for transport, however, remains largely an institutional practice.
  
  
  OBJECTIVE
  To evaluate the hypothesis that transport ventilation goals of intubated pediatric patients are better achieved using an FIR compared to an SIR.
  
  
  METHODS
  This randomized crossover simulation study compared the performance of SIR and FIR among anesthesia providers in a pediatric transport scenario. Subjects hand-ventilated a test lung while simultaneously maneuvering a stretcher bed to simulate patient transport. Hand ventilation was carried out using a Jackson-Rees circuit (FIR) and a Laerdal pediatric silicone resuscitator (SIR). The primary outcome was the proportion of total breaths delivered within the predefined target PIP/PEEP range (30+/- 3, 10+/- 3 cm H2O). Secondary outcomes included proportion of total breaths delivered with operationally defined unacceptable breath variables (PIP > 35 cm H2O or PEEP < 5 cm H2O).
  
  
  RESULTS
  Overall, participants were four times more likely to deliver target breaths and one-third less likely to deliver unacceptable breaths using the FIR compared to the SIR. When comparing device performance, a 44% increase in the proportions of target breaths and a 40.4% decrease in unacceptable breaths using the FIR were observed (P < 0.0001 for both).
  
  
  CONCLUSIONS
  Hand ventilation during patient transport is superior using the FIR compared to the SIR to achieve target ventilatory goals and avoid unacceptable ventilatory cycles.
authors: Department of Anesthesia, University of Saskatchewan, Saskatoon, SK, Canada.
authors: Malcolm J
authors: MJ
authors: Lucy
authors: Jonathan J
authors: JJ
authors: Gamble
authors: Brian L
authors: BL
authors: Daku
authors: Rhonda D
authors: RD
authors: Bryce
authors: Masud
authors: M
authors: Rana
mesh_terms: D018592:Cross-Over Studies; D004779:Environment Design; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal; D008168:Lung / Q000033:anatomy & histology; D008953:Models, Anatomic; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D014187:Transportation of Patients / Q000379:methods*; D016896:Treatment Outcome
keywords: artificial; intensive care; mechanical; pulmonary ventilation; respiration; resuscitation; transportation of patients; ventilators