Peak pressure and tidal volume are affected by how the neonatal self-inflating bag is handled

J Pediatr (Rio J). 2009 May-Jun;85(3):217-22. doi: 10.2223/JPED.1886. Epub 2009 Mar 23.
[Article in English, Portuguese]


Objective: To evaluate how different ways of handling the neonatal self-inflating bag influences peak pressure and tidal volume.

Methods: This is an experimental study involving 141 different professionals (physicians, resident physicians, physiotherapists, nurses and nursing technicians), who ventilated an artificial lung, adjusted to simulate the lung of a term neonate, using a self-inflating bag. Each professional handled the ventilator in five different ways: a) using both hands (10 fingers); and, with only one hand, b) five fingers, c) four fingers, d) three fingers and e) two fingers. Peak pressure and tidal volume data were recorded by the artificial lung equipment.

Results: Both variables showed high variability, from 2.5 to 106.3 cmH2O (mean = 39.73 cmH2O; 95%CI 37.32-42.13) for peak pressure, and from to 4 to 88 mL (mean = 39.56 mL; 95%CI 36.86-42.25) for tidal volume. There was no significant influence of the profession on any of the variables (p > 0.05). However, bag handling significantly influenced both peak pressure and tidal volume (p < 0.0001), which were higher when the operator used both hands.

Conclusion: The results indicate that most professionals delivered excessively high peak pressures and tidal volumes, which could increase the risk of barotrauma and volutrauma, especially when both hands were used to ventilate. On the other hand, a small number of professionals delivered insufficient pressure and volume for adequate lung expansion and ventilation. The delivery of inadequate ventilation was not dependent on profession.

MeSH terms

  • Artificial Organs*
  • Hand
  • Humans
  • Infant, Newborn
  • Inspiratory Capacity / physiology
  • Lung / physiology*
  • Pressure*
  • Respiration, Artificial / instrumentation
  • Respiration, Artificial / methods*
  • Statistics, Nonparametric
  • Term Birth
  • Tidal Volume / physiology
  • Ventilators, Mechanical