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首页> 外文期刊>Paediatric anaesthesia >Artificial ventilation during transport: A randomized crossover study of manual resuscitators with comparison to mechanical ventilators in a simulation model
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Artificial ventilation during transport: A randomized crossover study of manual resuscitators with comparison to mechanical ventilators in a simulation model

机译：运输过程中的人工通风：手动复苏器的随机交叉研究与模拟模型中的机械呼吸机比较

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Abstract Background Positive‐pressure ventilation in critically ill patients is commonly administered via a manual resuscitation device or a mechanical ventilator during transport. Our group previously compared delivered ventilation parameters between a self‐inflating resuscitator and a flow‐inflating resuscitator during simulated in‐hospital pediatric transport.[1][Lucy MJ, 2014] However, unequal group access to inline pressure manometry may have biased our results. In this study, we examined the performance of the self‐inflating resuscitator and the flow‐inflating resuscitator, both equipped with inline manometry, and several mechanical ventilators to deliver prescribed ventilation parameters during simulated pediatric transport. Methods Thirty anesthesia providers were randomized to initial resuscitator device used to hand ventilate a test lung. The resuscitators studied were a Jackson‐Rees circuit (flow‐inflating resuscitator) or a Laerdal pediatric silicone resuscitator (self‐inflating resuscitator), both employing manometers. The scenario was repeated using several mechanical transport ventilators (Hamilton‐T1, LTV ? 1000, and LTV ? 1200). The primary outcome was the proportion of total breaths delivered within the predefined target PIP / PEEP range (30?±?3, 10?±?3?cm H 2 O). Results The Hamilton‐T1 outperformed the other ventilators for breaths in the recommended range (χ 2 ?=?2284, df ?= 2, P ??.001) and with no breaths in the unacceptable range (χ 2 ?=?2333, df ?=?2, P ??.001). Hamilton‐T1 also outperformed all human providers in proportion of delivered acceptable and unacceptable breaths (χ 2 ?=?4540, df ?=?3, P ??.001 and χ 2 ?=?639, df ?=?3, P ??.001, respectively). Compared with the flow‐inflating resuscitator, the self‐inflating resuscitator was associated with greater odds of breaths falling outside the recommended range (Odds ratio (95% CI ): 1.81 (1.51‐2.17)) or unacceptable (Odds ratio (95% CI ): 1.63 (1.48‐1.81)). Conclusion This study demonstrates that a majority of breaths delivered by manual resuscitation device fall outside of target range regardless of provider experience or device type. The mechanical ventilator (Hamilton‐T1) outperforms the other positive‐pressure ventilation methods with respect to delivery of important ventilation parameters. In contrast, 100% of breaths delivered by the LTV 1200 were deemed unacceptable.
机译：摘要在交通过程中通常通过手动复苏装置或机械呼吸机常用的背景下患者正压通风。我们的小组以前比较了自膨胀复苏器和流动复苏器之间的送入通风参数在模拟的在医院的儿科的儿科运输期间。[1] [Lucy MJ，2014]然而，不平等的群体进入内联压力测量可能偏离我们的结果。在本研究中，我们检查了自充气复苏器和流量复苏器的性能，都配备有内联体测压，以及几个机械呼吸机，以在模拟的儿科运输期间提供规定的通风参数。方法有30个麻醉提供者随机分配给初始复苏器装置，用于携带通风测试肺。研究的复苏器是杰克逊 - REES电路（流量膨胀复苏器）或衣物儿科有机硅复苏器（自充气复苏器），都采用压力计。使用几种机械传输呼吸机（Hamilton-T1，LTV？1000和LTVα1200）重复该方案。主要结果是在预定偏定的靶带/窥视范围内输送的总呼吸的比例（30？±3,10？±3？cm H 2 O）。结果汉密尔顿-T1在推荐范围内呼吸的其他呼吸机（χ2？=Δ2284，df？= 2，p≤00），并且在不可接受范围内没有呼吸（χ2？=？ 2333，df？=Δ2，p？＆ 001）。 Hamilton-T1也以递送的可接受和不可接受的呼吸比例地表现出所有人类提供者（χ2？= 4540，DF？=Δ3，p？001和χ2？=？639，DF？=？3 ，p？＆ 001分别）。与流量膨胀复苏器相比，自充气复苏器与落在推荐范围之外的呼吸较大的呼吸差异相关（差距（95％CI）：1.81（1.51-2.17）或不可接受（差距（95％CI） ）：1.63（1.48-1.81））。结论本研究表明，无论提供商体验还是设备类型，手动复苏设备都落在目标范围之外的大部分呼吸。机械呼吸机（Hamilton-T1）相对于重要通风参数的递送优于其他正压通气方法。相比之下，LTV 1200提供的100％呼吸被认为是不可接受的。

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