Manual Bag Valve Mask Ventilation Performance Among Respiratory Therapists: A Cross-Sectional Study and Current Implications for COVID-19 Patients

Abstract

Background:

Previous research has shown that providers consistently demonstrate poor technique with manual ventilation in all populations. Manual ventilation with high peak pressures and high tidal volumes is particularly concerning among patients susceptible to lung injury, including those infected with COVID-19. This study sought to examine manual ventilation performance among RTs in a simulation model.

Methods:

Respiratory therapists (n=98) participated in a simulation model, which included a standard BVM and an IMT Analytics SL 2000 2L and an IMT Analytics Citrex H5 (IMT analytics, Switzerland). Participants were instructed to normally ventilate a manikin for 18 breaths following a preset variable frequency indicated by a flashing light for 90 seconds. A short survey was administered to participants while the study was in progress. Descriptive statistics were computed to determine the mean ventilation estimates. Multiple linear regression was utilized to determine associated provider predictors with the outcomes: delivered tidal volume, pressure and flow. The university institutional approval board approved this study.

Results:

Among all respiratory therapist participants, the mean ventilation parameters include a tidal volume of 599.70 mL, peak pressure of 26.35 cm H₂O, peak flow of 77.20 L/min, inspiratory time of 0.75 seconds and an inspiratory rise time of 0.49 seconds. Those who had greater than 10 years of experience and the highest self-rated confidence (n=28), ventilated the most unsafely with the highest mean values of volume (631.43 mL), peak pressure (30.55 cm H₂O) and peak flow (86.10 L/min). Confidence level was associated with higher mean pressure and higher flow delivered via bag valve mask.

Conclusions:

The group with the greatest experience and highest confidence level delivered higher tidal volumes, pressures and flows compared to their peers. Our results emphasize the urgent need to create an intervention that allows providers to deliver safe and optimal manual ventilation, particularly in vulnerable patients such as those with COVID-19.