Evaluation of handbagging in a pressure-support ventilation model

Introduction: Uncontrolled handbagging with an open-end Jackson Reese (JR) bag may result in insufficient ventilation. This study evaluates ventilatory rate (f), Peak Insp. Pressure (PIP) and Pos. End Exp. Pressure(PEEP) in a simulation handbaggingmodel.

Methods: 48 staffmembers blindly imitated 2 ventilatory settings during 1 min. by handbagging. Case 1:PIP = 35 cmH₂O; PEEP = 4 cmH₂O; f = 40 /min. Case 2:PIP = 20 cmH₂O; PEEP = 4 cmH₂O; f = 60/min. The JR-bag was conducted to an artificial lung(Drager). PIP,PEEP and f measured at the entrance of the artificial lung using an Ohmeda, DT-XX sensor. Each individual printed result of PIP was scored as a multiple of ten percent from the asked PIP; said to be 100%. PEEP results were scored as <2, 2-4, >4 cm H₂O.

Results: The mean interindividual f in both simulations was too high, respectively 59 ± 18 (case 1) and 68 ± 21 (case 2) per minute. Intraindividual f was often the same in case 1 + 2 (p < 0.001). The intraindividual registrations of PIP showed huge variations. Next tables show results of all individual beats(%):

Table 1

Conclusions: Regarding a great intra and interindividual difference uncontrolled handbagging in a simulation model results in too high f and PIP and insufficient PEEP levels. Reduced interruptions of mechanical ventilation and protection of handbagging by limitation of PIP is advised.