Assessment of Ventilation Using Adult and Pediatric Manual Resuscitators in a Simulated Adult Patient.

BACKGROUND: The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device. METHODS: This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV). RESULTS: A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0-2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0-467.3] mL/min, P < .001). CONCLUSIONS: Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject.

Frequency response of the leap motion controller and its suitability for measuring tremor.

Although tremor is one of the most common movement disorders, it is evaluated using relatively coarse clinical scales. We propose to measure tremor in clinical settings using the Leap Motion Controller (LMC), which is a markerless motion capture sensor that has a low cost, zero set-up time, and dynamic accuracy of 1.2 mm. However, the frequency response of the LMC has not been characterized, so its ability to track oscillations such as tremor is unknown. To characterize the frequency response of the LMC, we measured the position of a mannequin hand simultaneously with the LMC and a high-resolution encoder while the mannequin hand oscillated at various combinations of frequency (1-15 Hz) and amplitudes (0.01-30 mm). We calculated the magnitude ratio and phase shift of the LMC and found the bandwidth of the LMC to range from 0-3 Hz to 0-5 Hz for tremor amplitudes greater than the dynamic accuracy. This bandwidth is too small to accurately measure most tremors. However, we developed an inverse filter to estimate the actual tremor amplitude and phase despite the limited bandwidth. Over the combinations of frequency and amplitude mentioned above, the inverse filter estimated the actual tremor amplitude and phase with errors of 3% and 2%, respectively.