Comparison of efficacy of three devices of manual positive pressure ventilation: a mannequin-based study

BACKGROUND: We compared the efficacy of and consistency in manual ventilation by trained healthcare professionals using three devices: self-inflating bag, flow-inflating bag, and T-piece resuscitator. METHODS: Prospective analytical study at a level III Neonatal unit of a tertiary care hospital. Forty participants (consultants, postgraduates, interns, and neonatal nurses – 10 each) manually ventilated a mannequin with the above three devices for three minutes each. This procedure was video recorded. The pressure delivered during the three minutes and the breath rates for the first minute, second minute, and third minute were analyzed. Descriptive statistics were used to describe the study population and group statistics were used for various parameters of interest. Factorial analysis of variance was conducted to determine the main effects of device and specialty of users. RESULTS: The mean (SD) peak inspiratory pressure of T-piece resuscitator was 16.5 (1.2), self-inflating bag (SIB) was 20.7 (4.4), and flow-inflating bag (AB) was 21.2 (5.0). The mean (SD) positive end expiratory pressure of T-piece resuscitator was 4.7 (0.9) cm of H(2)O and AB was 1.8 (1.7) cm of H(2)O. The maximum pressure delivered by T-piece resuscitator was 17.5, AB was 26.2, and SIB was 25.2 cm of H(2)O. Clinically appropriate breath rates were delivered using all of the devices. More effective breath rates were delivered using T-piece. There was no significant difference among the professional groups. CONCLUSIONS: The T-piece resuscitator provides the most consistent pressures and is most effective. Level of training has no influence on pressures delivered during manual ventilation.