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Volker Wenzel - One of the best experts on this subject based on the ideXlab platform.
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Head position angles to open the upper airway differ less with the head positioned on a support.
The American journal of emergency medicine, 2012Co-Authors: Thomas Mitterlechner, Peter Paal, Achim Von Goedecke, Lukas Kuehnelt-leddhin, Alexander Strasak, Günther Putz, Nikolaus Gravenstein, Volker WenzelAbstract:Abstract Introduction The aim of the study was to assess the effects of positioning the head on a support on "head position angles" to optimally open the upper airway during Bag-Valve Mask ventilation. Methods We ventilated the lungs of anesthetized adults with a Bag-Valve Mask and the head positioned with (n = 30) or without a support (n = 30). In both groups, head position angles and ventilation parameters were measured with the head positioned in (1) neutral position, (2) in a position deemed optimal for ventilation by the investigator, and (3) in maximal extension. Results Between groups ("head with/without a support") and between head positions within each group, head position angles and ventilation parameters differed ( P P P Conclusions In the head-with-a-support group, when compared with the head-without-a-support group, head position angles differed less, indicating a decreased potential for failure during Bag-Valve Mask ventilation with the head on a support. Moreover, in the head-with-a-support group, ventilation parameters differed less between head positions, and ventilation improved. These findings suggest a potential benefit of positioning the head on a support during Bag-Valve Mask ventilation.
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Effects of face Mask ventilation in apneic patients with a resuscitation ventilator in comparison with a Bag-Valve-Mask
The Journal of emergency medicine, 2006Co-Authors: Achim Von Goedecke, Volker Wenzel, Wolfgang G Voelckel, Christoph Hörmann, Horst G. Wagner-berger, Angelika Zecha-stallinger, Thomas J. Luger, C KellerAbstract:Bag-Valve-Mask ventilation in an unprotected airway is often applied with a high flow rate or a short inflation time and, therefore, a high peak airway pressure, which may increase the risk of stomach inflation and subsequent pulmonary aspiration. Strategies to provide more patient safety may be a reduction in inspiratory flow and, therefore, peak airway pressure. The purpose of this study was to evaluate the effects of Bag-Valve-Mask ventilation vs. a resuscitation ventilator on tidal volume, peak airway pressure, and peak inspiratory flow rate in apneic patients. In a crossover design, 40 adults were ventilated during induction of anesthesia with either a Bag-Valve-Mask device with room air, or an oxygen-powered, flow-limited resuscitation ventilator. The study endpoints of expired tidal volume, minute volume, respiratory rate, peak airway pressure, delta airway pressure, peak inspiratory flow rate and inspiratory time fraction were measured using a pulmonary monitor. When compared with the resuscitation ventilator, the Bag-Valve-Mask resulted in significantly higher (mean ± SD) peak airway pressure (15.3 ± 3 vs. 14.1 ± 3 cm H2O, respectively; p = 0.001) and delta airway pressure (14 ± 3 vs. 12 ± 3 cm H2O, respectively; p < 0.001), but significantly lower oxygen saturation (95 ± 3 vs. 98 ± 1%, respectively; p < 0.001). No patient in either group had clinically detectable stomach inflation. We conclude that the resuscitation ventilator is at least as effective as traditional Bag-Valve-Mask or face Mask resuscitation in this population of very controlled elective surgery patients.
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Effects of decreasing inspiratory times during simulated Bag-Valve-Mask ventilation.
Resuscitation, 2005Co-Authors: Achim Von Goedecke, C Keller, Volker Wenzel, Kevin Bowden, Andrea GabrielliAbstract:Abstract During CPR, an inspiratory time of 2 s is recommended when the airway is unprotected; indicating that ∼30% of the resuscitation attempt is spent on ventilation, but not on chest compressions. Since survival rates may not decrease when ventilation levels are relatively low, and uninterrupted chest compressions with a constant rate of ∼100/min have been shown to be lifesaving, it may be beneficial to cut down the time spent on ventilation, and instead, increase the time for chest compressions. In an established bench model of a simulated unprotected airway, we evaluated if inspiratory time can be decreased from 2 to 1 s at different lower oesophageal sphincter pressure (LOSP) levels during ventilation with a Bag-Valve-Mask device. In comparison with an inspiratory time of 2 s, 1 s resulted in significantly (p
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effects of decreasing peak flow rate on stomach inflation during Bag Valve Mask ventilation
Resuscitation, 2004Co-Authors: Achim Von Goedecke, Volker Wenzel, Horst G Wagnerberger, Karl H Stadlbauer, Anette C Krismer, Juliusz Jakubaszko, Christian Bratschke, C KellerAbstract:Abstract Reducing inspiratory flow rate and peak airway pressure may be important in order to minimise the risk of stomach inflation when ventilating an unprotected airway with positive pressure ventilation. This study was designed to yield enough power to determine whether employing an inspiratory gas flow limiting Bag-Valve device (SMART Bag ® , O-Two Medical Technologies Inc., Ontario, Canada) would also decrease the likelihood of stomach inflation in an established bench model of a simulated unintubated respiratory arrest patient. The bench model consists of a training lung (lung compliance, 50 ml/cm H 2 O; airway resistance, 4 cm H 2 O/l/s) and a Valve simulating lower oesophageal sphincter opening at a pressure of 19 cm H 2 O. One hundred and ninety-one emergency medicine physicians were requested to ventilate the manikin utilising a standard single-person technique for 1 min (respiratory rate, 12/min; V t , 500 ml) with both a standard adult Bag-Valve-Mask and the SMART Bag ® . The volunteers were blinded to the experimental design of the model until completion of the experimental protocol. The SMART Bag ® versus standard Bag-Valve-Mask resulted in significantly ( P 2 O versus 16 ± 3 cm H 2 O), respiratory rates (13 ± 3 breaths per min versus 14 ± 4 breaths per min), incidence of stomach inflation (4.2% versus 38.7%) and median stomach inflation volumes (351 [range, 18–1211 ml] versus 1426 [20–5882 ml]); lung tidal volumes (538 ± 97 ml versus 533 ± 97 ml) were comparable. Inspiratory to expiratory ratios were significantly ( P ® reduced inspiratory flow, mean airway pressure and both the incidence and actual volume of stomach inflation compared with a standard Bag-Valve-Mask device while maintaining delivered lung tidal volumes and increasing the inspiratory to expiratory ratio.
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Effects of decreasing peak flow rate on stomach inflation during Bag-Valve-Mask ventilation.
Resuscitation, 2004Co-Authors: Achim Von Goedecke, Volker Wenzel, Horst G. Wagner-berger, Karl H Stadlbauer, Anette C Krismer, Juliusz Jakubaszko, Christian Bratschke, C. KellerAbstract:Reducing inspiratory flow rate and peak airway pressure may be important in order to minimise the risk of stomach inflation when ventilating an unprotected airway with positive pressure ventilation. This study was designed to yield enough power to determine whether employing an inspiratory gas flow limiting Bag-Valve device (SMART Bag, O-Two Medical Technologies Inc., Ontario, Canada) would also decrease the likelihood of stomach inflation in an established bench model of a simulated unintubated respiratory arrest patient. The bench model consists of a training lung (lung compliance, 50 ml/cm H2O; airway resistance, 4 cm H2O/l/s) and a Valve simulating lower oesophageal sphincter opening at a pressure of 19 cm H(2)O. One hundred and ninety-one emergency medicine physicians were requested to ventilate the manikin utilising a standard single-person technique for 1 min (respiratory rate, 12/min; Vt, 500 ml) with both a standard adult Bag-Valve-Mask and the SMART Bag. The volunteers were blinded to the experimental design of the model until completion of the experimental protocol. The SMART Bag versus standard Bag-Valve-Mask resulted in significantly (P < 0.001) lower (mean +/- S.D.) mean airway pressure (14 +/- 2 cm H2O versus 16 +/- 3 cm H2O), respiratory rates (13 +/- 3 breaths per min versus 14 +/- 4 breaths per min), incidence of stomach inflation (4.2% versus 38.7%) and median stomach inflation volumes (351 [range, 18-1211 ml] versus 1426 [20-5882 ml]); lung tidal volumes (538 +/- 97 ml versus 533 +/- 97 ml) were comparable. Inspiratory to expiratory ratios were significantly (P < 0.001) increased (1.7 +/- 0.5 versus 1.5 +/- 0.6). In conclusion, the SMART Bag reduced inspiratory flow, mean airway pressure and both the incidence and actual volume of stomach inflation compared with a standard Bag-Valve-Mask device while maintaining delivered lung tidal volumes and increasing the inspiratory to expiratory ratio.
Tom Silfvast - One of the best experts on this subject based on the ideXlab platform.
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a comparison of the laryngeal tube and Bag Valve Mask ventilation by emergency medical technicians a feasibility study in anesthetized patients
Anesthesia & Analgesia, 2005Co-Authors: Jouni Kurola, Matti Turunen, Juhapekka Laakso, J Gorski, Heikki J Paakkonen, Tom SilfvastAbstract:Airway management is of major importance in emergency care. The basic technique for all health care providers is Bag-Valve Mask (BVM) ventilation, which requires skill and may be difficult to perform. Endotracheal intubation, which is the advanced method for securing the airway, is a demanding techn
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airway management in cardiac arrest comparison of the laryngeal tube tracheal intubation and Bag Valve Mask ventilation in emergency medical training
Resuscitation, 2004Co-Authors: Jouni Kurola, Juhapekka Laakso, J Gorski, Heikki J Paakkonen, Heini Harve, T Kettunen, Tom SilfvastAbstract:Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and Bag-Valve Mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P<0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P<0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.
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Airway management in cardiac arrest—comparison of the laryngeal tube, tracheal intubation and Bag-Valve Mask ventilation in emergency medical training
Resuscitation, 2004Co-Authors: Jouni Kurola, Juhapekka Laakso, J Gorski, Heini Harve, T Kettunen, Heikki Paakkonen, Tom SilfvastAbstract:Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and Bag-Valve Mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P < 0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P < 0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.
Jouni Kurola - One of the best experts on this subject based on the ideXlab platform.
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a comparison of the laryngeal tube and Bag Valve Mask ventilation by emergency medical technicians a feasibility study in anesthetized patients
Anesthesia & Analgesia, 2005Co-Authors: Jouni Kurola, Matti Turunen, Juhapekka Laakso, J Gorski, Heikki J Paakkonen, Tom SilfvastAbstract:Airway management is of major importance in emergency care. The basic technique for all health care providers is Bag-Valve Mask (BVM) ventilation, which requires skill and may be difficult to perform. Endotracheal intubation, which is the advanced method for securing the airway, is a demanding techn
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airway management in cardiac arrest comparison of the laryngeal tube tracheal intubation and Bag Valve Mask ventilation in emergency medical training
Resuscitation, 2004Co-Authors: Jouni Kurola, Juhapekka Laakso, J Gorski, Heikki J Paakkonen, Heini Harve, T Kettunen, Tom SilfvastAbstract:Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and Bag-Valve Mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P<0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P<0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.
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Airway management in cardiac arrest—comparison of the laryngeal tube, tracheal intubation and Bag-Valve Mask ventilation in emergency medical training
Resuscitation, 2004Co-Authors: Jouni Kurola, Juhapekka Laakso, J Gorski, Heini Harve, T Kettunen, Heikki Paakkonen, Tom SilfvastAbstract:Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and Bag-Valve Mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P < 0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P < 0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.
P Schmucker - One of the best experts on this subject based on the ideXlab platform.
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smaller tidal volumes with room air are not sufficient to ensure adequate oxygenation during Bag Valve Mask ventilation
Resuscitation, 2000Co-Authors: Volker Dorges, Volker Wenzel, Ahamed H Idris, Hartmut Ocker, Sonke Hagelberg, P SchmuckerAbstract:The European Resuscitation Council has recommended decreasing tidal volume during basic life support ventilation from 800 to 1200 ml, as recommended by the American Heart Association, to 500 ml in order to minimise stomach inflation. However, if oxygen is not available at the scene of an emergency, and small tidal volumes are given during basic life support ventilation with a paediatric self-inflatable Bag and room-air (21% oxygen), insufficient oxygenation and/or inadequate ventilation may result. When apnoea occurred after induction of anaesthesia, 40 patients were randomly allocated to room-air ventilation with either an adult (maximum volume, 1500 ml) or paediatric (maximum volume, 700 ml) self-inflatable Bag for 5 min before intubation. When using an adult (n=20) versus paediatric (n=20) self-inflatable Bag, mean +/-SEM tidal volumes and tidal volumes per kilogram were significantly (P<0.0001) larger (719+/-22 vs. 455+/-23 ml and 10.5+/-0.4 vs. 6.2+/-0.4 ml kg(-1), respectively). Compared with an adult self-inflatable Bag, Bag-Valve-Mask ventilation with room-air using a paediatric self-inflatable Bag resulted in significantly (P<0.01) lower paO(2) values (73+/-4 vs. 87+/-4 mmHg), but comparable carbon dioxide elimination (40+/-2 vs. 37+/-1 mmHg; NS). In conclusion, our results indicate that smaller tidal volumes of approximately 6 ml kg(-1) ( approximately 500 ml) given with a paediatric self-inflatable Bag and room-air maintain adequate carbon dioxide elimination, but do not result in sufficient oxygenation during Bag-Valve-Mask ventilation. Thus, if small (6 ml kg(-1)) tidal volumes are being used during Bag-Valve-Mask ventilation, additional oxygen is necessary. Accordingly, when additional oxygen during Bag-Valve-Mask ventilation is not available, only large tidal volumes of approximately 11 ml kg(-1) were able to maintain both sufficient oxygenation and carbon dioxide elimination.
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airway management during cardiopulmonary resuscitation a comparative study of Bag Valve Mask laryngeal Mask airway and combitube in a bench model
Resuscitation, 1999Co-Authors: V Doerges, Volker Wenzel, Carsten Sauer, Hartmut Ocker, P SchmuckerAbstract:Gastric inflation and subsequent regurgitation are a potential risk of ventilation during cardiopulmonary resuscitation (CPR). In respect of recent investigations, principal respiratory components such as respiratory system compliance, resistance and lower esophageal sphincter pressure were adapted according to CPR situations. The purpose of our study was to assess lung ventilation and gastric inflation when performing ventilation with Bag–Valve–Mask, laryngeal Mask airway, and combitube in a bench model simulating an unintubated cardiac arrest patient. Twenty-one student nurses, without any experience in basic life support measures, ventilated the bench model with all three devices. Mean (±S.D.) gastric inflation with the laryngeal Mask airway (seven cases) was significantly lower than with the Bag–Valve–Mask (0.6±0.81 vs 3.0±2.1 l min−1, P 5 l when using the Bag–Valve–Mask, whereas mean (±S.D.) 1-min lung volumes with both laryngeal Mask airway and combitube were significantly higher (laryngeal Mask airway 15.0±6.6 l, combitube 16.6±6.8 l vs Bag–Valve–Mask 4.8±2.7 l, P<0.01). The time for insertion was significantly faster with both Bag–Valve–Mask and laryngeal Mask airway compared with the combitube (median: Bag–Valve–Mask 22 s, laryngeal Mask airway 37 s vs combitube 70 s, P<0.01). This may tip the scales towards using the laryngeal Mask airway during basic life support airway management. In conclusion, our data suggests that both laryngeal Mask airway and combitube may be appropriate alternatives for airway management in the first few minutes of CPR.
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Airway management during cardiopulmonary resuscitation--a comparative study of Bag-Valve-Mask, laryngeal Mask airway and combitube in a bench model.
Resuscitation, 1999Co-Authors: V Doerges, Volker Wenzel, Carsten Sauer, Hartmut Ocker, P SchmuckerAbstract:Gastric inflation and subsequent regurgitation are a potential risk of ventilation during cardiopulmonary resuscitation (CPR). In respect of recent investigations, principal respiratory components such as respiratory system compliance, resistance and lower esophageal sphincter pressure were adapted according to CPR situations. The purpose of our study was to assess lung ventilation and gastric inflation when performing ventilation with Bag–Valve–Mask, laryngeal Mask airway, and combitube in a bench model simulating an unintubated cardiac arrest patient. Twenty-one student nurses, without any experience in basic life support measures, ventilated the bench model with all three devices. Mean (±S.D.) gastric inflation with the laryngeal Mask airway (seven cases) was significantly lower than with the Bag–Valve–Mask (0.6±0.81 vs 3.0±2.1 l min−1, P 5 l when using the Bag–Valve–Mask, whereas mean (±S.D.) 1-min lung volumes with both laryngeal Mask airway and combitube were significantly higher (laryngeal Mask airway 15.0±6.6 l, combitube 16.6±6.8 l vs Bag–Valve–Mask 4.8±2.7 l, P
Amanda Kao - One of the best experts on this subject based on the ideXlab platform.
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comparison of Bag Valve Mask hand sealing techniques in a simulated model
Annals of Emergency Medicine, 2014Co-Authors: David Otten, Michael M Liao, Robert Wolken, Ivor S Douglas, Ramya Mishra, Amanda KaoAbstract:Study objective Bag-Valve-Mask ventilation remains an essential component of airway management. Rescuers continue to use both traditional 1- or 2-handed Mask-face sealing techniques, as well as a newer modified 2-handed technique. We compare the efficacy of 1-handed, 2-handed, and modified 2-handed Bag-Valve-Mask technique. Methods In this prospective, crossover study, health care providers performed 1-handed, 2-handed, and modified 2-handed Bag-Valve-Mask ventilation on a standardized ventilation model. Subjects performed each technique for 5 minutes, with 3 minutes' rest between techniques. The primary outcome was expired tidal volume, defined as percentage of total possible expired tidal volume during a 5-minute bout. A specialized inline monitor measured expired tidal volume. We compared 2-handed versus modified 2-handed and 2-handed versus 1-handed techniques. Results We enrolled 52 subjects: 28 (54%) men, 32 (62%) with greater than or equal to 5 actual emergency Bag-Valve-Mask situations. Median expired tidal volume percentage for 1-handed technique was 31% (95% confidence interval [CI] 17% to 51%); for 2-handed technique, 85% (95% CI 78% to 91%); and for modified 2-handed technique, 85% (95% CI 82% to 90%). Both 2-handed (median difference 47%; 95% CI 34% to 62%) and modified 2-handed technique (median difference 56%; 95% CI 29% to 65%) resulted in significantly higher median expired tidal volume percentages compared with 1-handed technique. The median expired tidal volume percentages between 2-handed and modified 2-handed techniques did not significantly differ from each other (median difference 0; 95% CI –2% to 2%). Conclusion In a simulated model, both 2-handed Mask-face sealing techniques resulted in higher ventilatory tidal volumes than 1-handed technique. Tidal volumes from 2-handed and modified 2-handed techniques did not differ. Rescuers should perform Bag-Valve-Mask ventilation with 2-handed techniques.
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Comparison of Bag-Valve-Mask hand-sealing techniques in a simulated model.
Annals of emergency medicine, 2013Co-Authors: David Otten, Michael M Liao, Robert Wolken, Ivor S Douglas, Ramya Mishra, Amanda Kao, Whitney Barrett, Erin Drasler, Richard L Byyny, Jason S HaukoosAbstract:Bag-Valve-Mask ventilation remains an essential component of airway management. Rescuers continue to use both traditional 1- or 2-handed Mask-face sealing techniques, as well as a newer modified 2-handed technique. We compare the efficacy of 1-handed, 2-handed, and modified 2-handed Bag-Valve-Mask technique. In this prospective, crossover study, health care providers performed 1-handed, 2-handed, and modified 2-handed Bag-Valve-Mask ventilation on a standardized ventilation model. Subjects performed each technique for 5 minutes, with 3 minutes' rest between techniques. The primary outcome was expired tidal volume, defined as percentage of total possible expired tidal volume during a 5-minute bout. A specialized inline monitor measured expired tidal volume. We compared 2-handed versus modified 2-handed and 2-handed versus 1-handed techniques. We enrolled 52 subjects: 28 (54%) men, 32 (62%) with greater than or equal to 5 actual emergency Bag-Valve-Mask situations. Median expired tidal volume percentage for 1-handed technique was 31% (95% confidence interval [CI] 17% to 51%); for 2-handed technique, 85% (95% CI 78% to 91%); and for modified 2-handed technique, 85% (95% CI 82% to 90%). Both 2-handed (median difference 47%; 95% CI 34% to 62%) and modified 2-handed technique (median difference 56%; 95% CI 29% to 65%) resulted in significantly higher median expired tidal volume percentages compared with 1-handed technique. The median expired tidal volume percentages between 2-handed and modified 2-handed techniques did not significantly differ from each other (median difference 0; 95% CI -2% to 2%). In a simulated model, both 2-handed Mask-face sealing techniques resulted in higher ventilatory tidal volumes than 1-handed technique. Tidal volumes from 2-handed and modified 2-handed techniques did not differ. Rescuers should perform Bag-Valve-Mask ventilation with 2-handed techniques. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
