Pediatric Self-Inflating Resuscitators: The Dangers of Improper Setup

BackgroundSelf-inflating resuscitators (SIRs) are often used in pediatric resuscitation. Improper setup of the SIR can lead to inadequate ventilation and oxygenation.ObjectivesTo present clinical scenarios in which SIRs delivered inadequate tidal volumes due to improper use. Second, to evaluate tidal volumes delivered using SIRs at varying lung compliances with the manometer and pop-off valve port open and closed. Third, to suggest methods to overcome improper use.MethodsFive pediatric resuscitators were tested under conditions simulating normal lungs, lungs with moderately decreased compliance, and lungs with poor compliance (0.015, 0.010, and 0.005 L/cm H2O, respectively) to determine volumes delivered with proper SIR setup (manometer and pop-off valve closed) and improper SIR setup (manometer or pop-off valve open).ResultsWith each SIR, an open manometer port or an open pop-off valve (improper setup) led to significant decreases in volume delivered. In normal lung compliance, the proper setup delivered 149 ± 10 cc, vs. 112 ± 12 cc, 106 ± 25 cc, and 90 ± 14 cc (pop-off open, manometer open, and both open, respectively). In poor lung compliance, the proper setup delivered 122 ± 13 cc, vs. 56 ± 10 cc, 70 ± 17 cc, and 44 ± 7 cc (pop-off open, manometer open, and both open, respectively). All differences above are significant (p < 0.0001).ConclusionsIn a normal lung, the volumes delivered by SIRs are significantly decreased with the pop-off valve and manometer port open. Proper set-up of the SIR becomes even more important when lung compliance is poor.