Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations?
Identifieur interne : 000962 ( Pmc/Checkpoint ); précédent : 000961; suivant : 000963Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations?
Auteurs : A. Khoury [France] ; F. S. Sall [France] ; A. De Luca [France] ; A. Pugin [France] ; S. Pili-Floury [France] ; L. Pazart [France] ; G. Capellier [France, Australie]Source :
- BioMed Research International [ 2314-6133 ] ; 2016.
Abstract
Url:
DOI: 10.1155/2016/4521767
PubMed: 27294119
PubMed Central: 4884794
Affiliations:
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Pazart</name><affiliation wicri:level="1"><nlm:aff id="I2">Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation></author><author><name sortKey="Capellier, G" sort="Capellier, G" uniqKey="Capellier G" first="G." last="Capellier">G. Capellier</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I4">Monash University, Melbourne, VIC 3800, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Monash University, Melbourne, VIC 3800</wicri:regionArea><wicri:noRegion>VIC 3800</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27294119</idno><idno type="pmc">4884794</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884794</idno><idno type="RBID">PMC:4884794</idno><idno type="doi">10.1155/2016/4521767</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002337</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002337</idno><idno type="wicri:Area/Pmc/Curation">002187</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002187</idno><idno type="wicri:Area/Pmc/Checkpoint">000962</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000962</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations?</title><author><name sortKey="Khoury, A" sort="Khoury, A" uniqKey="Khoury A" first="A." last="Khoury">A. Khoury</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation></author><author><name sortKey="Sall, F S" sort="Sall, F S" uniqKey="Sall F" first="F. S." last="Sall">F. S. Sall</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation></author><author><name sortKey="De Luca, A" sort="De Luca, A" uniqKey="De Luca A" first="A." last="De Luca">A. De Luca</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation></author><author><name sortKey="Pugin, A" sort="Pugin, A" uniqKey="Pugin A" first="A." last="Pugin">A. Pugin</name><affiliation wicri:level="1"><nlm:aff id="I2">Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation></author><author><name sortKey="Pili Floury, S" sort="Pili Floury, S" uniqKey="Pili Floury S" first="S." last="Pili-Floury">S. Pili-Floury</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Anaesthesia and Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Anaesthesia and Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation></author><author><name sortKey="Pazart, L" sort="Pazart, L" uniqKey="Pazart L" first="L." last="Pazart">L. Pazart</name><affiliation wicri:level="1"><nlm:aff id="I2">Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation></author><author><name sortKey="Capellier, G" sort="Capellier, G" uniqKey="Capellier G" first="G." last="Capellier">G. Capellier</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon</wicri:regionArea><wicri:noRegion>25000 Besançon</wicri:noRegion><wicri:noRegion>25000 Besançon</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I4">Monash University, Melbourne, VIC 3800, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Monash University, Melbourne, VIC 3800</wicri:regionArea><wicri:noRegion>VIC 3800</wicri:noRegion></affiliation></author></analytic><series><title level="j">BioMed Research International</title><idno type="ISSN">2314-6133</idno><idno type="eISSN">2314-6141</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Introduction.</italic> Manikin-based studies for evaluation of ventilation performance show high heterogeneity in the analysis and experimental methods used as we pointed out in previous studies. In this work, we aim to evaluate these potential limitations and propose a new analysis methodology to reliably assess ventilation performance.<italic> Methods.</italic> One hundred forty healthcare providers were selected to ventilate a manikin with two adult self-inflating bags in random order. Ventilation parameters were analysed using different published analysis methods compared to ours.<italic> Results.</italic> Using different methods impacts the evaluation of ventilation efficiency which ranges from 0% to 45.71%. Our new method proved relevant and showed that all professionals tend to cause hyperventilation and revealed a significant relationship between professional category, grip strength of the hand keeping the mask, and ventilation performance (<italic>p</italic> = 0.0049 and <italic>p</italic> = 0.0297, resp.).<italic> Conclusion.</italic> Using adequate analysis methods is crucial to avoid many biases. Extrapolations to humans still have to be taken with caution as many factors impact the evaluation of ventilation performance. Healthcare professionals tend to cause hyperventilation with current devices. We believe this problem could be prevented by implementing monitoring tools in order to give direct feedback to healthcare professionals regarding ventilation efficiency and ventilatory parameter values.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Harrison, R R" uniqKey="Harrison R">R. R. Harrison</name></author><author><name sortKey="Maull, K I" uniqKey="Maull K">K. I. Maull</name></author><author><name sortKey="Keenan, R L" uniqKey="Keenan R">R. L. Keenan</name></author><author><name sortKey="Boyan, C P" uniqKey="Boyan C">C. P. Boyan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hess, D" uniqKey="Hess D">D. Hess</name></author><author><name sortKey="Baran, C" uniqKey="Baran C">C. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Biomed Res Int</journal-id><journal-id journal-id-type="iso-abbrev">Biomed Res Int</journal-id><journal-id journal-id-type="publisher-id">BMRI</journal-id><journal-title-group><journal-title>BioMed Research International</journal-title></journal-title-group><issn pub-type="ppub">2314-6133</issn><issn pub-type="epub">2314-6141</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27294119</article-id><article-id pub-id-type="pmc">4884794</article-id><article-id pub-id-type="doi">10.1155/2016/4521767</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations?</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-7084-1508</contrib-id><name><surname>Khoury</surname><given-names>A.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-8351-0406</contrib-id><name><surname>Sall</surname><given-names>F. S.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-0922-7311</contrib-id><name><surname>De Luca</surname><given-names>A.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pugin</surname><given-names>A.</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pili-Floury</surname><given-names>S.</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pazart</surname><given-names>L.</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Capellier</surname><given-names>G.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I4"><sup>4</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</aff><aff id="I2"><sup>2</sup>Clinical Investigation Centre, INSERM CIC-1431, University of Franche-Comté, Medical Centre, 25000 Besançon, France</aff><aff id="I3"><sup>3</sup>Department of Anaesthesia and Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France</aff><aff id="I4"><sup>4</sup>Monash University, Melbourne, VIC 3800, Australia</aff><author-notes><corresp id="cor1">*A. Khoury: <email>akhoury@chu-besancon.fr</email></corresp><fn fn-type="other"><p>Academic Editor: Han-Ping Wu</p></fn></author-notes><pub-date pub-type="ppub"><year>2016</year></pub-date><pub-date pub-type="epub"><day>16</day><month>5</month><year>2016</year></pub-date><volume>2016</volume><elocation-id>4521767</elocation-id><history><date date-type="received"><day>1</day><month>2</month><year>2016</year></date><date date-type="rev-recd"><day>7</day><month>4</month><year>2016</year></date><date date-type="accepted"><day>19</day><month>4</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016 A. Khoury et al.</copyright-statement><copyright-year>2016</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p><italic>Introduction.</italic> Manikin-based studies for evaluation of ventilation performance show high heterogeneity in the analysis and experimental methods used as we pointed out in previous studies. In this work, we aim to evaluate these potential limitations and propose a new analysis methodology to reliably assess ventilation performance.<italic> Methods.</italic> One hundred forty healthcare providers were selected to ventilate a manikin with two adult self-inflating bags in random order. Ventilation parameters were analysed using different published analysis methods compared to ours.<italic> Results.</italic> Using different methods impacts the evaluation of ventilation efficiency which ranges from 0% to 45.71%. Our new method proved relevant and showed that all professionals tend to cause hyperventilation and revealed a significant relationship between professional category, grip strength of the hand keeping the mask, and ventilation performance (<italic>p</italic> = 0.0049 and <italic>p</italic> = 0.0297, resp.).<italic> Conclusion.</italic> Using adequate analysis methods is crucial to avoid many biases. Extrapolations to humans still have to be taken with caution as many factors impact the evaluation of ventilation performance. Healthcare professionals tend to cause hyperventilation with current devices. We believe this problem could be prevented by implementing monitoring tools in order to give direct feedback to healthcare professionals regarding ventilation efficiency and ventilatory parameter values.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Operating process of the new analysis algorithm. This figure shows the evaluation of one-minute sliding windows with a shift of three ventilation cycles. The 1st window is considered insufficient as there are only 5 adequate ventilation cycles. The 2nd window is excessive as mean <italic>V</italic><sub><italic>T</italic></sub> > 600 mL. The 3rd window is excessive as <italic>V</italic><sub><italic>R</italic></sub> > 15 bpm. Global ventilation performance of the whole test is considered excessive as the majority of sliding windows are excessive. <sup><italic>∗</italic></sup>Adequate ventilation cycles.</p></caption><graphic xlink:href="BMRI2016-4521767.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Percentage of excessive, efficient, and insufficient ventilation tests for professional categories (<italic>n</italic> = 280).</p></caption><graphic xlink:href="BMRI2016-4521767.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>Percentage of excessive, efficient, and insufficient ventilation tests for grip strength categories of the hand keeping the mask (<italic>n</italic> = 274<sup><italic>∗</italic></sup>, <sup><italic>∗</italic></sup>6 missing values).</p></caption><graphic xlink:href="BMRI2016-4521767.003"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Different definitions and judgment criteria identified in the literature and ILCOR guidelines. </p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Judgment criteria</th><th align="center" rowspan="1" colspan="1">Definition 1</th><th align="center" rowspan="1" colspan="1">Definition 2</th><th align="center" rowspan="1" colspan="1">Definition 3</th><th align="center" rowspan="1" colspan="1">Definition 4</th><th align="center" rowspan="1" colspan="1">Definition 5</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Tidal volume </td><td align="center" rowspan="1" colspan="1">450–525 mL<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">400–600 mL</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">450–525 mL</td></tr><tr><td align="left" rowspan="1" colspan="1">Ventilation rate</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">8–10 bpm<sup><italic>∗∗</italic></sup></td><td align="center" rowspan="1" colspan="1">10–15 bpm</td><td align="center" rowspan="1" colspan="1">8–10 bpm</td></tr></tbody></table><table-wrap-foot><fn><p><sup><italic>∗</italic></sup>6-7 mL·kg<sup>−1</sup>, 75 kg of IBW; <sup><italic>∗∗</italic></sup>bpm: breaths per minute. </p></fn></table-wrap-foot></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Characteristics of study population (<italic>n</italic> = 140).</p></caption><table frame="hsides" rules="groups"><tbody><tr><td align="left" rowspan="1" colspan="1"><italic>Mean age ± SD (years)</italic></td><td align="center" rowspan="1" colspan="1">37.28 ± 8.97</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Sex (n, %)</italic></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="center" rowspan="1" colspan="1">47 (33.57%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="center" rowspan="1" colspan="1">93 (66.43%) </td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Professional category (n, %)</italic></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Physicians</td><td align="center" rowspan="1" colspan="1">45 (32.14%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Nurses</td><td align="center" rowspan="1" colspan="1">45 (32.14%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> First-aid workers</td><td align="center" rowspan="1" colspan="1">50 (35.71%)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Professional experience (n, %) </italic></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> High (≥10 years)</td><td align="center" rowspan="1" colspan="1">63 (45.00%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Medium (5 ≤ <italic>n</italic> < 10 years)</td><td align="center" rowspan="1" colspan="1">36 (25.70%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Little (<5 years)</td><td align="center" rowspan="1" colspan="1">41 (29.30%)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Handedness (n, %)</italic></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Right-handed</td><td align="center" rowspan="1" colspan="1">118 (84.29%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Left-handed</td><td align="center" rowspan="1" colspan="1">14 (10.00%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Ambidextrous</td><td align="center" rowspan="1" colspan="1">8 (5.71%)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Size of the hand squeezing the bag (n, %)</italic></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Large (≥23 cm)</td><td align="center" rowspan="1" colspan="1">21 (15.00%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Medium (19 ≤ <italic>n</italic> < 23 cm)</td><td align="center" rowspan="1" colspan="1">101 (72.14%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Small (15 ≤ <italic>n</italic> < 19 cm)</td><td align="center" rowspan="1" colspan="1">18 (12.86%)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Grip strength (n, %)</italic></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Hand squeezing the bag</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> High (≥40 kgF)</td><td align="center" rowspan="1" colspan="1">53 (37.90%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Medium (20 ≤ <italic>n</italic> < 40 kgF)</td><td align="center" rowspan="1" colspan="1">65 (46.40%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Weak (0 ≤ <italic>n</italic> < 20 kgF)</td><td align="center" rowspan="1" colspan="1">22 (15.70%)</td></tr><tr><td align="left" rowspan="1" colspan="1">Hand keeping the mask<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> High (≥40 kgF)</td><td align="center" rowspan="1" colspan="1">38 (27.70%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Medium (20 ≤ <italic>n</italic> < 40 kgF)</td><td align="center" rowspan="1" colspan="1">68 (49.60%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Weak (0 ≤ <italic>n</italic> < 20 kgF) </td><td align="center" rowspan="1" colspan="1">31 (22.60%)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>BVM type used frequently (n, %)</italic></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Ambu®</td><td align="center" rowspan="1" colspan="1">76 (54.29%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Laerdal®</td><td align="center" rowspan="1" colspan="1">3 (2.14%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Both</td><td align="center" rowspan="1" colspan="1">39 (27.86%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Neither</td><td align="center" rowspan="1" colspan="1">22 (15.71%)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Estimated manual ventilation performance (n, %)</italic><sup><bold>∗</bold><bold>∗</bold></sup></td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Good</td><td align="center" rowspan="1" colspan="1">55 (39.57%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Medium</td><td align="center" rowspan="1" colspan="1">83 (59.71%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Bad</td><td align="center" rowspan="1" colspan="1">1 (0.72%)</td></tr></tbody></table><table-wrap-foot><fn><p>SD: standard deviation; <sup><italic>∗</italic></sup>3 missing values; <sup><italic>∗∗</italic></sup>1 missing value.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label><caption><p>Ventilation parameter values measured during all the 5-minute ventilation tests (<italic>n</italic> = 280), realized with 140 participants ventilating with two different BVM.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Mean (SD)</th><th align="center" rowspan="1" colspan="1">Lower quartile</th><th align="center" rowspan="1" colspan="1">Upper quartile</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Instantaneous ventilation rate (<italic>V</italic><sub><italic>R</italic></sub>, bpm)</td><td align="center" rowspan="1" colspan="1">24.09 (9.47)</td><td align="center" rowspan="1" colspan="1">17.20</td><td align="center" rowspan="1" colspan="1">29.09</td></tr><tr><td align="left" rowspan="1" colspan="1">Tidal volume (<italic>V</italic><sub><italic>T</italic></sub>, mL)</td><td align="center" rowspan="1" colspan="1">333.94 (124.19)</td><td align="center" rowspan="1" colspan="1">245.60</td><td align="center" rowspan="1" colspan="1">419.95</td></tr><tr><td align="left" rowspan="1" colspan="1">BVM insufflation volume (<italic>V</italic><sub>ins</sub>, mL)</td><td align="center" rowspan="1" colspan="1">590.20 (193.31)</td><td align="center" rowspan="1" colspan="1">458.11</td><td align="center" rowspan="1" colspan="1">723.40</td></tr><tr><td align="left" rowspan="1" colspan="1">Gastric tidal volume (<italic>V</italic><sub><italic>G</italic></sub>, mL)</td><td align="center" rowspan="1" colspan="1">37.58 (25.13)</td><td align="center" rowspan="1" colspan="1">18.92</td><td align="center" rowspan="1" colspan="1">52.43</td></tr><tr><td align="left" rowspan="1" colspan="1">Lung peak flow (PF<sub>Lung</sub>, L·min<sup>−1</sup>)</td><td align="center" rowspan="1" colspan="1">39.99 (16.53)</td><td align="center" rowspan="1" colspan="1">28.40</td><td align="center" rowspan="1" colspan="1">50.16</td></tr><tr><td align="left" rowspan="1" colspan="1">BVM peak flow (PF<sub>BVM</sub>, L·min<sup>−1</sup>)</td><td align="center" rowspan="1" colspan="1">69.26 (28.07)</td><td align="center" rowspan="1" colspan="1">49.16</td><td align="center" rowspan="1" colspan="1">85.92</td></tr><tr><td align="left" rowspan="1" colspan="1">Gastric peak flow (PF<sub><italic>G</italic></sub>, L·min<sup>−1</sup>)</td><td align="center" rowspan="1" colspan="1">5.35 (4.33)</td><td align="center" rowspan="1" colspan="1">2.53</td><td align="center" rowspan="1" colspan="1">7.34</td></tr></tbody></table></table-wrap><table-wrap id="tab4" orientation="portrait" position="float"><label>Table 4</label><caption><p>Manual ventilation efficiency (<italic>n</italic> (%)) using different analysis methods and definitions. <italic>n</italic> = 140 healthcare professionals for Methods 1 and 2; <italic>n</italic> = 54,770 ventilation cycles for Method 3.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Analysis methods</th><th align="center" rowspan="1" colspan="1">Definition 1</th><th align="center" rowspan="1" colspan="1">Definition 2</th><th align="center" rowspan="1" colspan="1">Definition 3</th><th align="center" rowspan="1" colspan="1">Definition 4</th><th align="center" rowspan="1" colspan="1">Definition 5</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Method 1 (overall mean value analysis)</td><td align="center" rowspan="1" colspan="1">0 (0.00%)</td><td align="center" rowspan="1" colspan="1">0 (0.00%)</td><td align="center" rowspan="1" colspan="1">0 (0.00%)</td><td align="center" rowspan="1" colspan="1">0 (0.00%)</td><td align="center" rowspan="1" colspan="1">0 (0.00%)</td></tr><tr><td align="left" rowspan="1" colspan="1">Method 2 (individual mean value analysis)</td><td align="center" rowspan="1" colspan="1">27 (19.29%)</td><td align="center" rowspan="1" colspan="1">64 (45.71%)</td><td align="center" rowspan="1" colspan="1">0 (0.00%)</td><td align="center" rowspan="1" colspan="1">36 (25.71%)</td><td align="center" rowspan="1" colspan="1">0 (0.00%)</td></tr><tr><td align="left" rowspan="1" colspan="1">Method 3 (breath-by-breath analysis)</td><td align="center" rowspan="1" colspan="1">9232 (16.86%)</td><td align="center" rowspan="1" colspan="1">21913 (40.01%)</td><td align="center" rowspan="1" colspan="1">1883 (3.44%)</td><td align="center" rowspan="1" colspan="1">7860 (14.35%)</td><td align="center" rowspan="1" colspan="1">222 (0.41%)</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Australie</li><li>France</li></country></list><tree><country name="France"><noRegion><name sortKey="Khoury, A" sort="Khoury, A" uniqKey="Khoury A" first="A." last="Khoury">A. Khoury</name></noRegion><name sortKey="Capellier, G" sort="Capellier, G" uniqKey="Capellier G" first="G." last="Capellier">G. Capellier</name><name sortKey="De Luca, A" sort="De Luca, A" uniqKey="De Luca A" first="A." last="De Luca">A. De Luca</name><name sortKey="De Luca, A" sort="De Luca, A" uniqKey="De Luca A" first="A." last="De Luca">A. De Luca</name><name sortKey="Khoury, A" sort="Khoury, A" uniqKey="Khoury A" first="A." last="Khoury">A. Khoury</name><name sortKey="Pazart, L" sort="Pazart, L" uniqKey="Pazart L" first="L." last="Pazart">L. Pazart</name><name sortKey="Pili Floury, S" sort="Pili Floury, S" uniqKey="Pili Floury S" first="S." last="Pili-Floury">S. Pili-Floury</name><name sortKey="Pugin, A" sort="Pugin, A" uniqKey="Pugin A" first="A." last="Pugin">A. Pugin</name><name sortKey="Sall, F S" sort="Sall, F S" uniqKey="Sall F" first="F. S." last="Sall">F. S. Sall</name><name sortKey="Sall, F S" sort="Sall, F S" uniqKey="Sall F" first="F. S." last="Sall">F. S. Sall</name></country><country name="Australie"><noRegion><name sortKey="Capellier, G" sort="Capellier, G" uniqKey="Capellier G" first="G." last="Capellier">G. Capellier</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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