Armando Carlos Franco de Godoy

Oxygen outflow delivered by manually operated self-inflating resuscitation bags in patients breathing spontaneously

OBJECTIVE To determine the oxygen outflow delivered by seven different models of manually operated self-inflating resuscitation bags (with and without an oxygen reservoir connected), which were tested using different oxygen supply rates without manipulating the bag, by simulating their use in patients breathing spontaneously. METHODS The oxygen outflow was measured using a wall oxygen flow meter and a flow meter/respirometer attached to the bag, together with another flow meter/respirometer attached to the patient connection port. The resuscitation bags that allow the connection of an oxygen reservoir were tested with and without this device. All resuscitation bags were tested using oxygen supply rates of 1, 5, 10, and 15 L/min. Statistical analyses were performed using analysis of variance and t-tests. RESULTS The resuscitation bags that allow the connection of an oxygen reservoir presented a greater oxygen outflow when this device was connected. All resuscitation bags delivered a greater oxygen outflow when receiving oxygen at a rate of 15 L/min. However, not all models delivered a sufficient oxygen outflow even when the two previous conditions were satisfied. CONCLUSIONS Of the resuscitation bags studied, those that allow the connection of an oxygen reservoir must have this reservoir connected to the bag when used as a source of oxygen in nonintubated spontaneously breathing patients. All of the models studied should receive oxygen at a rate > 15 L/min. It is not safe to use manually operated self-inflating resuscitation bags for this purpose without knowing their characteristics.

Alterações da pressão de pico inspiratório e do volume corrente fornecidos por reanimadores manuais com balão auto-inflável em função do fluxo de entrada de oxigênio utilizado

OBJECTIVE To assess possible alterations in the tidal volume and peak inspiratory pressure delivered by seven models of manually operated self-inflating resuscitation bags as a function of the oxygen supply rate used. METHODS The resuscitation bags tested were the following: Oxigel, models A and B; CE Reanimadores; ProtecSolutions; Missouri; Axmed; and Narcosul. For the measurements, a wall oxygen flow meter, a flow meter/respirometer, a resuscitation bag, a sensor (Tracer 5 unit), and a test lung were connected. In addition, the Tracer 5 unit was connected to a notebook computer. Oxygen supply rates of 1, 5, 10, and 15 L/min were used. RESULTS The tidal volume delivered by the Oxigel model A resuscitation bag when receiving oxygen at a rate of 15 L/min was approximately 99% greater than that delivered when receiving oxygen at a rate of 1 L/min. Similarly, peak inspiratory pressure was approximately 155% greater. Under the same conditions, the tidal volume delivered by the Narcosul resuscitation bag was 48% greater, and peak inspiratory pressure was 105% greater. The remaining resuscitation bags tested showed no significant alterations in the tidal volume or peak inspiratory pressure delivered. CONCLUSIONS Under the resistance and compliance conditions used, the resuscitation bags in which the oxygen inflow is directly to the interior of the bag had the patient valve stuck at the inspiratory position when receiving oxygen at a rate >or= 5 L/min, significantly increasing the tidal volume and peak inspiratory pressure delivered. This did not occur with the resuscitation bags in which the oxygen inflow is directed to the exterior of the bag.

Comparison of the FiO2 delivered by seven models of the self-inflating bag-mask system

JUSTIFICATIVA E OBJETIVOS: Devido ao fato dos reanimadores com sistema balao-mascara auto-inflaveis fabricados e/ou comercializados no Brasil serem amplamente disponiveis e utilizados em servicos de saude extra e intra-hospitalares, este estudo teve o objetivo de determinar as fracoes de O2 ofertadas por sete reanimadores recebendo diferentes fluxo de O2. METODO: Sete reanimadores com sistema balao-mascara auto-inflaveis foram testados na Unidade Respiratoria do HC/UNICAMP. Um fluxometro de O2 de parede foi conectado ao reanimador que recebia fluxo de O2 de 1, 5, 10 e 15 L.min-1, sendo estes conectados a um pulmao-teste. Os reanimadores que tem a capacidade de se conectar um reservatorio de O2 foram testados com e sem esse acessorio. Foram efetuadas 20 medidas consecutivas e determinada a media. RESULTADOS: Apenas um reanimador apresentou oferta de fracao de O2 pouco abaixo do limite minimo preconizado (0,80), quando utilizado com o reservatorio de O2. Sem esse dispositivo acoplado todos os reanimadores atingiram o limite minimo de fracao de O2 preconizada (0,40). Os reanimadores que nao apresentam a possibilidade de acoplar o reservatorio de O2 apresentaram maior oferta de O2 em relacao aos outros reanimadores. CONCLUSOES: Todos os reanimadores que possuem a opcao de acoplagem do reservatorio de O2 forneceram maior concentracao de O2 com esse acessorio. Os reanimadores que nao tem possibilidade de acoplar o reservatorio de O2 apresentaram maior oferta de O2 em relacao aos outros que podem ser acoplados ao reservatorio quando usados sem esse acessorio.BACKGROUND AND OBJECTIVES Since resuscitators with self-inflating bag-mask systems manufactured and/or commercialized in Brazil are widely available and used in health services, both out- and intra-hospitals, the objective of this study was to determine the O2 fractions delivered by seven resuscitators receiving different O2 flows. METHODS Seven resuscitators with self-inflating bag-mask systems were tested at the Respiratory Unit of the HC/UNICAMP. A wall O2 flowmeter was connected to the resuscitator that received an O2 flow of 1, 5, 10, and 15 L min(-1) and those were connected to a test lung. Resuscitators capable of being connected to an O2 reservoir were tested with and without this accessory Twenty consecutive measurements were performed and the mean determined. RESULTS Only one resuscitator delivered an O2 fraction slightly below the accepted limit (0.80) when used with the O2 reservoir. Without this device, all resuscitators achieved the minimal limit of O2 fraction (0.40). Resuscitators not capable of being connected to an O2 reservoir delivered a higher O2. CONCLUSIONS All resuscitators capable of being connected to an O2 reservoir delivered a higher O2 concentration when connected to this device. Resuscitators that do not have this capability delivered a higher O2 concentration than the ones that could be connected to this device but are used without it.

Comparação da FiO2 fornecida por sete modelos de sistema balão-máscara auto-inflável

JUSTIFICATIVA E OBJETIVOS: Devido ao fato dos reanimadores com sistema balao-mascara auto-inflaveis fabricados e/ou comercializados no Brasil serem amplamente disponiveis e utilizados em servicos de saude extra e intra-hospitalares, este estudo teve o objetivo de determinar as fracoes de O2 ofertadas por sete reanimadores recebendo diferentes fluxo de O2. METODO: Sete reanimadores com sistema balao-mascara auto-inflaveis foram testados na Unidade Respiratoria do HC/UNICAMP. Um fluxometro de O2 de parede foi conectado ao reanimador que recebia fluxo de O2 de 1, 5, 10 e 15 L.min-1, sendo estes conectados a um pulmao-teste. Os reanimadores que tem a capacidade de se conectar um reservatorio de O2 foram testados com e sem esse acessorio. Foram efetuadas 20 medidas consecutivas e determinada a media. RESULTADOS: Apenas um reanimador apresentou oferta de fracao de O2 pouco abaixo do limite minimo preconizado (0,80), quando utilizado com o reservatorio de O2. Sem esse dispositivo acoplado todos os reanimadores atingiram o limite minimo de fracao de O2 preconizada (0,40). Os reanimadores que nao apresentam a possibilidade de acoplar o reservatorio de O2 apresentaram maior oferta de O2 em relacao aos outros reanimadores. CONCLUSOES: Todos os reanimadores que possuem a opcao de acoplagem do reservatorio de O2 forneceram maior concentracao de O2 com esse acessorio. Os reanimadores que nao tem possibilidade de acoplar o reservatorio de O2 apresentaram maior oferta de O2 em relacao aos outros que podem ser acoplados ao reservatorio quando usados sem esse acessorio.BACKGROUND AND OBJECTIVES Since resuscitators with self-inflating bag-mask systems manufactured and/or commercialized in Brazil are widely available and used in health services, both out- and intra-hospitals, the objective of this study was to determine the O2 fractions delivered by seven resuscitators receiving different O2 flows. METHODS Seven resuscitators with self-inflating bag-mask systems were tested at the Respiratory Unit of the HC/UNICAMP. A wall O2 flowmeter was connected to the resuscitator that received an O2 flow of 1, 5, 10, and 15 L min(-1) and those were connected to a test lung. Resuscitators capable of being connected to an O2 reservoir were tested with and without this accessory Twenty consecutive measurements were performed and the mean determined. RESULTS Only one resuscitator delivered an O2 fraction slightly below the accepted limit (0.80) when used with the O2 reservoir. Without this device, all resuscitators achieved the minimal limit of O2 fraction (0.40). Resuscitators not capable of being connected to an O2 reservoir delivered a higher O2. CONCLUSIONS All resuscitators capable of being connected to an O2 reservoir delivered a higher O2 concentration when connected to this device. Resuscitators that do not have this capability delivered a higher O2 concentration than the ones that could be connected to this device but are used without it.

Can manual hyperinflation maneuvers cause aspiration of oropharyngeal secretions in patients under mechanical ventilation

BACKGROUND AND OBJECTIVES To evaluate whether manual hyperinflation maneuvers can cause aspiration of oropharyngeal secretions in patients under mechanical ventilation. METHODS Adult patients under mechanical ventilation in whom a dye was injected in the oropharyngeal cavity and had their tracheal secretion aspirated after 30 minutes (min) participated in this study. In the event of dye slid, the patient was eliminated. The other patients were divided in Control Group: patients in whom tracheal secretions were aspirated after 30, 60, 120, and 180 min, and Experimental Group: after 30 min, manual hyperventilation maneuvers were performed and secretions were aspirated on the established intervals. RESULTS Forty-three patients were enrolled in this study. In 13, dye slippage was observed after 30 min, before allocating them into two groups. In the remaining 29 patients, 226 secretion samples were collected. In only two samples the presence of dye in the secretion was observed after manual hyperinflation maneuvers in the experimental group. CONCLUSION Manual hyperinflation maneuvers did not cause aspiration of oropharyngeal secretions in patients under mechanical ventilation.

Ventilação mecânica não invasiva em uma paciente com pancreatite aguda e insuficiência respiratória

Respiratory failure in acute pancreatitis is one of the prognostic factors for mortality and can lead to death in the first week of treatment. Therefore, much attention has been devoted to the respiratory complications of this condition. The most common pleuropulmonary complications of acute pancreatitis are inflammatory response syndrome, atelectasis, alveolar consolidation, and diaphragmatic dysfunction.

Failure of self-inflating manual resuscitator due to the presence of dried pulmonary secretions

BACKGROUND AND OBJECTIVES Self-inflating manual resuscitators (SIMR) are devices used to ventilate patients with ventilatory needs. These devices consist of a set of valves that work sequentially, and changes in their function may be harmful to patients. CASE REPORT During the use of SIMR, it was observed that the valve remained fixed due to the presence of dried pulmonary secretion, which made it impossible to ventilate the patient, but not manipulate the compressible unit. CONCLUSIONS This situation reaffirms that the resuscitator is a device that should be used by trained professionals because, although changes in functioning are rare, they can be potentially fatal.Summary Background and objectives Self-inflating manual resuscitators (SIMR) are devices used to ventilate patients with ventilatory needs. These devices consist of a set of valves that work sequentially, and changes in their function may be harmful to patients. Case report During the use of SIMR, it was observed that the valve remained fixed due to the presence of dried pulmonary secretion, which made it impossible to ventilate the patient, but not manipulate the compressible unit. Conclusions This situation reaffirms that the resuscitator is a device that should be used by trained professionals because, although changes in functioning are rare, they can be potentially fatal.

Falha no funcionamento do ressuscitador manual autoinflável devido à presença de secreções pulmonares ressecadas

JUSTIFICATIVA Y OBJETIVOS: Los resucitadores manuales autoinflables (RMA), son dispositivos utilizados para dar ventilaciones a pacientes con necesidad ventilatoria. Esos dispositivos estan compuestos por un conjunto de valvulas que trabajan de forma secuencial y las alteraciones en su funcionamiento pueden ser daninas para el paciente. RELATO DEL CASO: Durante la utilizacion de RMA, observamos que la valvula permanecio fija debido a la presencia de secrecion pulmonar resecada, lo que imposibilito la ventilacion del paciente, pero no la manipulacion de la unidad comprensible. CONCLUSIONES: Esa situacion muestra que el reanimador es un dispositivo que debe ser usado por profesionales entrenados, porque a pesar de que las alteraciones de funcionamiento sean algo raro, si ocurren pueden ser potencialmente fatales.

Manobras de hiperinflação manual podem causar aspiração de secreções orofaríngeas em paciente sob ventilação mecânica

JUSTIFICATIVA E OBJETIVO: Avaliar se manobra de hiperinsuflacao manual (HM) pode propiciar aspiracao das secrecoes orofaringeas em paciente sob ventilacao mecânica. METODOS: Participaram do estudo pacientes adultos sob ventilacao mecânica nos quais foi injetado corante na cavidade orofaringea e aspirada secrecao traqueal apos 30 minutos (min). Na ocorrencia de deslizamento do corante, o paciente foi eliminado. Os demais foram alocados em Grupo Controle: pacientes em que se aspiravam secrecoes traqueais apos 30, 60, 120 e 180 min e Grupo Experimental: apos 30 min, foram realizadas manobras de HM e aspirada secrecao nos intervalos estabelecidos. RESULTADOS: Estudaram-se 43 pacientes. Em 13, ocorreu deslizamento do corante apos 30 min antes da alocacao dos grupos. Os demais 29 pacientes forneceram 226 amostras de secrecoes. Houve presenca de secrecoes coradas em apenas duas amostras, apos realizacao de HM, em pacientes do grupo experimental. CONCLUSAO: A manobra de hiperinflacao manual nao propiciou aspiracao de secrecoes orofaringeas em paciente sob ventilacao mecânica.

Comparación de la FiO2 suministrada por siete modelos de sistema balón-máscara autoinflable

JUSTIFICATIVA E OBJETIVOS: Devido ao fato dos reanimadores com sistema balao-mascara auto-inflaveis fabricados e/ou comercializados no Brasil serem amplamente disponiveis e utilizados em servicos de saude extra e intra-hospitalares, este estudo teve o objetivo de determinar as fracoes de O2 ofertadas por sete reanimadores recebendo diferentes fluxo de O2. METODO: Sete reanimadores com sistema balao-mascara auto-inflaveis foram testados na Unidade Respiratoria do HC/UNICAMP. Um fluxometro de O2 de parede foi conectado ao reanimador que recebia fluxo de O2 de 1, 5, 10 e 15 L.min-1, sendo estes conectados a um pulmao-teste. Os reanimadores que tem a capacidade de se conectar um reservatorio de O2 foram testados com e sem esse acessorio. Foram efetuadas 20 medidas consecutivas e determinada a media. RESULTADOS: Apenas um reanimador apresentou oferta de fracao de O2 pouco abaixo do limite minimo preconizado (0,80), quando utilizado com o reservatorio de O2. Sem esse dispositivo acoplado todos os reanimadores atingiram o limite minimo de fracao de O2 preconizada (0,40). Os reanimadores que nao apresentam a possibilidade de acoplar o reservatorio de O2 apresentaram maior oferta de O2 em relacao aos outros reanimadores. CONCLUSOES: Todos os reanimadores que possuem a opcao de acoplagem do reservatorio de O2 forneceram maior concentracao de O2 com esse acessorio. Os reanimadores que nao tem possibilidade de acoplar o reservatorio de O2 apresentaram maior oferta de O2 em relacao aos outros que podem ser acoplados ao reservatorio quando usados sem esse acessorio.BACKGROUND AND OBJECTIVES Since resuscitators with self-inflating bag-mask systems manufactured and/or commercialized in Brazil are widely available and used in health services, both out- and intra-hospitals, the objective of this study was to determine the O2 fractions delivered by seven resuscitators receiving different O2 flows. METHODS Seven resuscitators with self-inflating bag-mask systems were tested at the Respiratory Unit of the HC/UNICAMP. A wall O2 flowmeter was connected to the resuscitator that received an O2 flow of 1, 5, 10, and 15 L min(-1) and those were connected to a test lung. Resuscitators capable of being connected to an O2 reservoir were tested with and without this accessory Twenty consecutive measurements were performed and the mean determined. RESULTS Only one resuscitator delivered an O2 fraction slightly below the accepted limit (0.80) when used with the O2 reservoir. Without this device, all resuscitators achieved the minimal limit of O2 fraction (0.40). Resuscitators not capable of being connected to an O2 reservoir delivered a higher O2. CONCLUSIONS All resuscitators capable of being connected to an O2 reservoir delivered a higher O2 concentration when connected to this device. Resuscitators that do not have this capability delivered a higher O2 concentration than the ones that could be connected to this device but are used without it.