The summary of this section by Stuart and Jan asks the question "why don't companies make BVMs with built-in expiratory ports?" and the answer is that some do and some don't. If folks are considering buying BVMs for their department, they should ensure that they have a built-in exp valve.
A colleague of mine has written a blog post on this topic with a list of BVMs available and more detail on the issues that Scott discussed. https://www.psnetwork.org/bvm-no-expiratory-valve-very-poor-preoxygenation/
Scott talked about having a pressure monitor on the BMV so as not to bag too forcefully. In lieu of such a monitor, he also talked about squeezing just the top of the bag and administering "small, tiny, little, wee breaths."
Another option could be taken from the NEJM PreVent trial ("Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults", Feb 28, 2019). Those who received BMV ventilation prior to intubation had "ventilation at 10 breaths per minute with the smallest volume required to generate a visible chest rise." This might be an easier end-point!
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6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)
Matthew Oliver - July 15, 2019 4:39 PM
Hi EM:RAP,
The summary of this section by Stuart and Jan asks the question "why don't companies make BVMs with built-in expiratory ports?" and the answer is that some do and some don't. If folks are considering buying BVMs for their department, they should ensure that they have a built-in exp valve.
A colleague of mine has written a blog post on this topic with a list of BVMs available and more detail on the issues that Scott discussed.
https://www.psnetwork.org/bvm-no-expiratory-valve-very-poor-preoxygenation/
Thanks for the great discussion Scott and Swami!
David G., M.D. - July 25, 2019 11:16 AM
Scott talked about having a pressure monitor on the BMV so as not to bag too forcefully. In lieu of such a monitor, he also talked about squeezing just the top of the bag and administering "small, tiny, little, wee breaths."
Another option could be taken from the NEJM PreVent trial ("Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults", Feb 28, 2019). Those who received BMV ventilation prior to intubation had "ventilation at 10 breaths per minute with the smallest volume required to generate a visible chest rise." This might be an easier end-point!