Background During the COVID-19 pandemic it is anticipated that there will be a shortage of mechanical ventilators available for patients in critical condition. This has sparked many discussions about rationing resources and withholding care; however, an alternative may be to implement manual ventilation in these situations instead. Manual ventilation and a safety device were assessed for efficacy of extended use, such as may be required during this pandemic. Methods To evaluate physical output characteristics of extended manual ventilation and efficacy of a barotrauma mitigation device, 47 medical students, nurses and medics completed two 1-hour manual ventilation sessions using the SmartLung 2000 Lung Simulator and 5300 Series Mass Flow Meter with a SPUR II resuscitator bag and endotracheal tube, mimicking a healthy adult with normal lung physiology, both with and without the Sotair device. Providers were randomised to complete their initial session either with or without the Sotair device. Findings Collected data show wide variability in tidal volume and peak pressure in unmitigated manual breaths despite prior training and independent exploration of the resuscitation equipment prior to testing. The mean (±SD) tidal volume with bag only was 563.9±128.8 mL and with the safety device 536.1±80.9 mL (p<0.0001). The mean peak inspiratory pressure with bag only was 17.2±6.3 cm H2O and with the safety device 14.9±2.4 cm H2O (p<0.0001). Interpretation While extended manual ventilation cannot replace mechanical ventilation, it is feasible with a safety device, which may reduce barotrauma, underventilation and overventilation. These results also demonstrate that withholding care and rationing resources may not be necessary.

中文翻译：

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人工通气代替机械通气的可行性

背景 在 COVID-19 大流行期间，预计可用于危重症患者的机械呼吸机将短缺。这引发了许多关于配给资源和扣留医疗的讨论；然而，替代方法可能是在这些情况下实施手动通风。评估了手动通风和安全装置的延长使用效果，例如在这次大流行期间可能需要的。方法 为了评估延长手动通气的物理输出特性和气压伤缓解装置的功效，47 名医学生、护士和医务人员使用 SmartLung 2000 肺模拟器和 5300 系列质量流量计与 SPUR II 复苏器完成了两个 1 小时的手动通气课程袋子和气管插管，模仿具有正常肺生理机能的健康成年人，无论是否使用 Sotair 设备。提供者被随机分配以使用或不使用 Sotair 设备完成他们的初始会话。结果 收集到的数据显示，尽管在测试前事先接受过培训和对复苏设备的独立探索，但未经缓解的手动呼吸的潮气量和峰值压力变化很大。仅袋装的平均 (±SD) 潮气量为 563.9±128.8 mL，安全装置为 536.1±80.9 mL (p<0.0001)。仅使用气囊时的平均峰值吸气压力为 17.2±6.3 cm H2O，使用安全装置时为 14.9±2.4 cm H2O (p<0.0001)。解释 虽然延长手动通气不能代替机械通气，但使用安全装置是可行的，这可以减少气压伤、通气不足和通气过度。