RESUMO
BACKGROUND: Although self-inflating bags are widely used for manual hyperinflation, they do not allow ventilation parameters, such as pressure or volume, to be set. We studied the ventilation performance of neonatal and pediatric self-inflating bags. METHODS: We asked 22 physiotherapists to manually hyperinflate 2 lung models (neonatal and pediatric), using self-inflating bags from 3 manufactures (Hudson, Laerdal, and JG Moriya), with flows of 0, 5, 10, and 15 L/min. A pneumotachograph recorded tidal volume (V(T)), peak inspiratory pressure (PIP), peak inspiratory flow (PIF), peak expiratory flow (PEF), and inspiratory time. RESULTS: The V(T), PIP, and inspiratory time delivered by the Hudson, Laerdal, and JG Moriya bags, in both neonatal and pediatric self-inflating bags, were significantly different (P < .001). The PEF and PIF delivered were different only when using the neonatal self-inflating bags (P < .001). The V(T), PIP, and PIF delivered with a flow of 0 L/min were lower than with 15 L/min (P < .05) with all the tested bags, in both the neonatal and pediatric sizes. CONCLUSIONS: The performance of the tested neonatal and pediatric bags varied by manufacturer and oxygen flow. There was an increase in VT, PIP, and PIF related to the increase of oxygen flow from 0 L/min to 15 L/min. The neonatal bags showed higher ventilation parameters variation than the pediatric bags.
Assuntos
Oxigenoterapia , Respiração com Pressão Positiva , Ressuscitação/instrumentação , Ventiladores Mecânicos/normas , Criança , Pesquisa Comparativa da Efetividade , Simulação por Computador , Desenho de Equipamento , Humanos , Recém-Nascido , Medidas de Volume Pulmonar/métodos , Modelos Biológicos , Monitorização Fisiológica , Oxigênio/administração & dosagem , Oxigenoterapia/instrumentação , Oxigenoterapia/métodos , Pediatria/instrumentação , Pediatria/métodos , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Distribuição Aleatória , Testes de Função Respiratória/métodosRESUMO
BACKGROUND: Manual hyperinflation (MH) is used to improve mucociliary clearance and alveolar expansion in mechanically ventilated patients. Despite the popularity of MH, studies with adults have shown considerable variability in the results from its use. This study assessed if professional training on the application of MH influences its performance. METHODS: An experimental study was conducted with physiotherapists, including 11 with previous professional experience (experienced) and 11 without previous experience (inexperienced). They applied MH in a test lung model using self-inflating bags in 2 sizes (infant and pediatric) from 3 manufacturers (Hudson, Laerdal, and JG Moriya). The test lung simulated the lung mechanics of a newborn and a pediatric patient in 2 different clinical situations: at normal and reduced compliance. The professionals were instructed to perform MH as described in the literature. Measurements of inspiratory volume, peak inspiratory pressure, peak inspiratory flow, and peak expiratory flow were recorded using a pneumotachograph in each condition. RESULTS: The delivered peak inspiratory flow was higher in the experienced group (P = .03) than in the inexperienced group. This result was observed in both neonatal and pediatric self-inflating bags. There was no difference in the parameters delivered between the experienced and inexperienced groups. CONCLUSIONS: The experienced and inexperienced groups were similar in their overall MH performance; the only difference was the observation of the highest PIF in the results from the experienced group.
Assuntos
Competência Clínica , Respiração Artificial/normas , Terapia Respiratória/normas , Adulto , Análise de Variância , Criança , Pré-Escolar , Estudos Cross-Over , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Mecânica Respiratória , Estatísticas não Paramétricas , Ventiladores MecânicosRESUMO
OBJETIVO:O reanimador manual autoinflável é um dispositivo que fornece ventilação com pressão positiva. Pesquisas mostram que, apesar da padronização dos reanimadores manuais autoinfláveis pela American Society for Testing and Materials, diversos fatores afetam o desempenho da ventilação, porém, os resultados são conflitantes. O objetivo desse estudo foi verificar as evidências dos fatores que influenciam a ventilação pulmonar com reanimadores manuais infantil/adulto por meio de uma revisão sistemática da literatura. FONTES DE DADOS: Foram incluídos artigos indexados nas bases Medline, Lilacs e SciELO publicados entre janeiro de 1986 e março de 2011. Utilizaram-se as palavras-chaves: "reanimador manual", "ressuscitador manual", "ventilação manual", "ventilação com pressão positiva", em inglês e português, além de "bag-valve". SÍNTESE DOS DADOS: Foram selecionados 45 artigos, sendo a maioria experimental. Os trabalhos compararam os reanimadores manuais por marcas, modelos e analisaram as características dos profissionais que os utilizam. Estudos verificaram que a eficácia da ventilação com os reanimadores manuais depende da marca, modelo e características funcionais do aparelho utilizado, assim como formação, treinamento e experiência do profissional que os manipula. Outros fatores que podem influenciar são a forma de compressão dos reanimadores manuais, o uso da válvula limitadora de pressão e o fluxo de oxigênio fornecido aos aparelhos. CONCLUSÕES: A variabilidade nos parâmetros ventilatórios fornecidos durante a ventilação com reanimadores manuais não permite uniformizar a técnica, o que prejudica a reanimação cardiopulmonar. Apesar da maioria dos reanimadores manuais parecer estar de acordo com padrões internacionais, os equipamentos devem ser avaliados antes de utilizados no ambiente clínico. Pouco se sabe sobre os modelos pediátricos e neonatais.
OBJECTIVE:The manual resuscitator (RM) is a device that provides positive pressure ventilation. Surveys conducted to assess the adequacy of manual resuscitators to American Society for Testing and Materials standards show that several factors affect manual ventilation. However, results are conflicting. The aim of this study was to verify evidence of factors that influence pediatric/adult pulmonary ventilation with manual resuscitator by a systematic review. DATA SOURCE: Original articles indexed in Medline, Lilacs and SciELO published from January 1986 to March 2011. The key-words used were: "manual resuscitator", "manual ventilation", "positive pressure ventilation" in Portuguese and English, as well as "bag-valve". DATA SYNTHESIS: 45 articles were selected, most of them experimental. The studies compared manual resuscitator brands and models, and analyzed the physical characteristics of professionals. The effectiveness of ventilation with manual resuscitator depends on the brand, model and functional characteristics of the equipment. Ventilation also varies with the education, training and experience of the professional who handles the equipment. Other factors that can influence effectiveness are the manual resuscitator compression form, the use of a pressure relief valve and the flow of oxygen provided to the manual resuscitator. CONCLUSIONS: The variability of ventilatory parameters during manual resuscitation does not allow a standardization of the technique, being harmful to cardiopulmonary resuscitation. Although most manual resuscitator seem to follow international standards, the equipment must be evaluated in the clinical settings. There are few studies about pediatric and neonatal manual resuscitator models.
