Can Providers Use Clinical Skills to Assess the Adequacy of Ventilation in Children During Bag-Valve Mask Ventilation?
| Autor: | Melissa L. Langhan, Heather J. Becker |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Bag valve mask ventilation
medicine.medical_specialty law.invention 03 medical and health sciences 0302 clinical medicine law Interquartile range Capnography 030225 pediatrics Medicine Humans Elective surgery Child Monitoring Physiologic medicine.diagnostic_test business.industry 030208 emergency & critical care medicine General Medicine medicine.disease Respiration Artificial Confidence interval Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Ventilation (architecture) Emergency Medicine Medical emergency Clinical Competence business Respiratory minute volume Clinical skills |
| Zdroj: | Pediatric emergency care. 36(12) |
| ISSN: | 1535-1815 |
| Popis: | Objective Bag-valve mask (BVM) ventilation requires both manual skill and clinical assessment of minute ventilation. Subjective factors can make supplying appropriate ventilation difficult. Capnography is not routinely used when ventilating nonintubated patients. Our objective was to determine if providers were able to maintain normal capnography values with BVM ventilation in pediatric patients based on clinical skills alone. Methods Providers (nurses, residents, and fellows) delivered 2 minutes of BVM respiratory support to healthy children during induction of anesthesia for elective surgery. All patients had standard monitoring including capnography, but providers were blinded to capnography data. Capnography data were video recorded; values between 30 and 50 mmHg were considered indicative of normal ventilation. Any deviation from this range for greater than 10 consecutive seconds was considered an episode of inappropriate ventilation. Main results Twenty-five providers-patient pairs were enrolled. Nineteen providers were anesthesia residents. The median age of patients was 5.3 years (interquartile range, 3.3-8.5 years). Nineteen providers (76%) had at least 1 episode of abnormal ventilation with a median of 2 episodes per provider (interquartile range, 0.5-2.5). Among these providers, total mean duration of abnormal ventilation was 57 seconds (95% confidence interval, 41-72) or 47% (95% confidence interval, 34%-60%) of the 2-minute period. Conclusions Normal ventilation is difficult to maintain among providers delivering BVM ventilation to pediatric patients without objective feedback. Incorporation of capnography monitoring may improve BVM ventilation in children. |
| Databáze: | OpenAIRE |
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