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Retention of ventilation skills by emergency nurses three months after training: SMART bag compared with standard bag

Melissa De Regge UGent, Catherine Vogels, Paul Calle UGent and Koenraad Monsieurs UGent (2004) RESUSCITATION. 62. p.319-320
abstract
Retention of ventilation skills by emergency nurses three and six months after training: Smart Bag compared with standard bag. De Regge Melissa, Vogels C, Calle PA, Monsieurs KG. Ghent University Hospital, Belgium and Cliniques Universitaires St. Luc, Brussels, Belgium. Background: The ERC 2000 Guidelines recommend tidal volumes (Vt) of only 400-600 ml and inspiratory times (Ti) between one and two seconds to reduce gastric insufflation (GI) with Bag-Valve-Mask (BVM) devices (1). Studies have shown that the SMART BAG® (SB, O-Two Medical Technologies Inc. Canada) reduces GI by the use of a pressure/flow responsive valve (2, 3). Purpose: 1. To assess ventilation skills of emergency department (ED) nurses with a Standard BVM (STBVM) and the SB before and after CPR training focusing on limiting Vt and prolonging Ti. We hypothesized that after 3 and 6 months the SB would facilitate the maintenance of good quality ventilation. 2. To identify ventilation parameters associated with GI. Materials and methods We utilized a CPR training manikin (Simulaids, USA) equipped with an oesophagus and a PEEP valve set at 20 cm H20 simulating the lower oesophageal sphincter pressure. Ti, Vt and peak pressure (Pp)were measured (CPRview®, Michigan Instruments, USA). GI was measured with a volume meter (Medishield, UK). Prior to training, 39 ED nurses performed CPR for 2 minutes, in pairs, using a STBVM (Laerdal, Norway) to assess their baseline skills. Immediately following training they were retested using an O-Two STBVM and a SB. Twenty nurses were retested after 3 months, 19 after 6 months. Efficient ventilation was defined as a mean Vt > 400 ml and GI < 50 ml/min. Mean values over 2 minutes are reported. Mann-Whitney U test and Fisher’s exact tests were used for analysis. Results: Before training: only 5/39 (13%) of nurses ventilated efficiently. 21/39 (54%) had GI, 15/39 (38%) had Vt < 400 ml. Immediately after training: STBVM: 20/39 (51%) of nurses ventilated efficiently. 6/39 (15%) had GI, 13/39 (33%) had Vt < 400 ml. SB: 16/37 (2 missing data) (43%) of nurses ventilated efficiently, none had GI. After 3 and 6 months: The number of nurses ventilating efficiently did not change significantly. When compared with base line (2/19), more nurses ventilated efficiently with SB (10/19) at 6 months but not with STBVM (5/19). Ventilation parameters: for all STBVM cases with Vt > 400 ml, cases without GI had longer Ti and lower Pp than cases with GI (Ti 1.29 s versus 1.00 s, p=0.003, Pp 17 cm H20 versus 8 cm H20, p<0.0001). SB cases with Vt > 400 ml had even longer Ti (1.47 s) and lower Pp (7.5 cm H20) than STBVM cases. Of all efficient ventilations with a STBVM, 11/37 (30%) had Vt > 600 ml Conclusions: 1. Skills assessment: a. Ventilation techniques at base line were poor with GI and hypoventilation as the major problems, justifying training. b. After training, only 47% of nurses ventilated efficiently, mainly because of hypoventilation. c. In contrast with STBVM, SB resulted in better skills after 6 months compared with base line. 2. Ventilation parameters: a. Short Ti and high Pp are associated with GI in the STBVM. b. The SB achieved good volumes at the longest Ti and lowest Pp. There was never GI with the SB. c. Long Ti and reduced Pp prevented GI with STBVM even at Vt > 600 ml. d. Training should focus on prolonging Ti and not only on limiting Vt. References: 1. de Latorre F, Nolan J, Robertson C, et al. European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support. Resuscitation 2001;48:211–21. 2. Wagner-Berger HG, Wenzel V, Voelckel WG, et al. A pilot study to evaluate the SMART BAG: a new pressure-responsive, gas-flow limiting bag-valve-mask device. Anesth Analg 2003;97(6):1686-9. 3. Wagner-Berger HG, Wenzel V, Stallinger A, et al. Decreasing peak flow rate with a new bag-valve-mask device: effects on respiratory mechanics, and gas distribution in a bench model of an unprotected airway. Resuscitation 2003;57(2):193-9.
Please use this url to cite or link to this publication:
author
organization
year
type
conference
publication status
published
subject
in
RESUSCITATION
volume
62
pages
319 - 320
publisher
Resuscitation
conference name
7th Scientific congress of the European Resuscitation Council
conference location
Budapest, Hungary
conference start
2004-09-08
conference end
2004-09-11
language
English
UGent publication?
yes
classification
C3
id
2972749
handle
http://hdl.handle.net/1854/LU-2972749
date created
2012-08-17 14:12:30
date last changed
2012-08-21 13:14:04
@inproceedings{2972749,
  abstract     = {Retention of ventilation skills by emergency nurses three and six months after training: Smart Bag\unmatched{f0d2} compared with standard bag. De Regge Melissa, Vogels C, Calle PA, Monsieurs KG. Ghent University Hospital, Belgium and Cliniques Universitaires St. Luc, Brussels, Belgium. Background: The ERC 2000 Guidelines recommend tidal volumes (Vt) of only 400-600 ml and inspiratory times (Ti) between one and two seconds to reduce gastric insufflation (GI) with Bag-Valve-Mask (BVM) devices (1). Studies have shown that the SMART BAG{\textregistered} (SB, O-Two Medical Technologies Inc. Canada) reduces GI by the use of a pressure/flow responsive valve (2, 3). Purpose: 1.\unmatched{0009}To assess ventilation skills of emergency department (ED) nurses with a Standard BVM (STBVM) and the SB before and after CPR training focusing on limiting Vt and prolonging Ti. We hypothesized that after 3 and 6 months the SB would facilitate the maintenance of good quality ventilation. 2.\unmatched{0009}To identify ventilation parameters associated with GI. Materials and methods We utilized a CPR training manikin (Simulaids, USA) equipped with an oesophagus and a PEEP valve set at 20 cm H20 simulating the lower oesophageal sphincter pressure. Ti, Vt and peak pressure (Pp)were measured (CPRview{\textregistered}, Michigan Instruments, USA). GI was measured with a volume meter (Medishield, UK). Prior to training, 39 ED nurses performed CPR for 2 minutes, in pairs, using a STBVM (Laerdal, Norway) to assess their baseline skills. Immediately following training they were retested using an O-Two STBVM and a SB. Twenty nurses were retested after 3 months, 19 after 6 months. Efficient ventilation was defined as a mean Vt {\textrangle} 400 ml and GI {\textlangle} 50 ml/min. Mean values over 2 minutes are reported. Mann-Whitney U test and Fisher{\textquoteright}s exact tests were used for analysis. Results: Before training: only 5/39 (13\%) of nurses ventilated efficiently. 21/39 (54\%) had GI, 15/39 (38\%) had Vt {\textlangle} 400 ml. Immediately after training: STBVM: 20/39 (51\%) of nurses ventilated efficiently. 6/39 (15\%) had GI, 13/39 (33\%) had Vt {\textlangle} 400 ml. SB: 16/37 (2 missing data) (43\%) of nurses ventilated efficiently, none had GI. After 3 and 6 months: The number of nurses ventilating efficiently did not change significantly. When compared with base line (2/19), more nurses ventilated efficiently with SB (10/19) at 6 months but not with STBVM (5/19). Ventilation parameters: for all STBVM cases with Vt {\textrangle} 400 ml, cases without GI had longer Ti and lower Pp than cases with GI (Ti 1.29 s versus 1.00 s, p=0.003, Pp 17 cm H20 versus 8 cm H20, p{\textlangle}0.0001). SB cases with Vt {\textrangle} 400 ml had even longer Ti (1.47 s) and lower Pp (7.5 cm H20) than STBVM cases. Of all efficient ventilations with a STBVM, 11/37 (30\%) had Vt {\textrangle} 600 ml Conclusions: 1.\unmatched{0009}Skills assessment: a.\unmatched{0009}Ventilation techniques at base line were poor with GI and hypoventilation as the major problems, justifying training. b.\unmatched{0009}After training, only 47\% of nurses ventilated efficiently, mainly because of hypoventilation. c.\unmatched{0009}In contrast with STBVM, SB resulted in better skills after 6 months compared with base line. 2.\unmatched{0009}Ventilation parameters: a.\unmatched{0009}Short Ti and high Pp are associated with GI in the STBVM. b.\unmatched{0009}The SB achieved good volumes at the longest Ti and lowest Pp. There was never GI with the SB. c.\unmatched{0009}Long Ti and reduced Pp prevented GI with STBVM even at Vt {\textrangle} 600 ml. d.\unmatched{0009}Training should focus on prolonging Ti and not only on limiting Vt. References: 1. de Latorre F, Nolan J, Robertson C, et al. European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support. Resuscitation 2001;48:211--21. 2. Wagner-Berger HG, Wenzel V, Voelckel WG, et al. A pilot study to evaluate the SMART BAG: a new pressure-responsive, gas-flow limiting bag-valve-mask device. Anesth Analg 2003;97(6):1686-9. 3. Wagner-Berger HG, Wenzel V, Stallinger A, et al. Decreasing peak flow rate with a new bag-valve-mask device: effects on respiratory mechanics, and gas distribution in a bench model of an unprotected airway. Resuscitation 2003;57(2):193-9.},
  author       = {De Regge, Melissa and Vogels, Catherine  and Calle, Paul and Monsieurs, Koenraad},
  booktitle    = {RESUSCITATION},
  language     = {eng},
  location     = {Budapest, Hungary},
  pages        = {319--320},
  publisher    = {Resuscitation},
  title        = {Retention of ventilation skills by emergency nurses three months after training: SMART bag compared with standard bag},
  volume       = {62},
  year         = {2004},
}

Chicago
De Regge, Melissa, Catherine Vogels, Paul Calle, and Koenraad Monsieurs. 2004. “Retention of Ventilation Skills by Emergency Nurses Three Months After Training: SMART Bag Compared with Standard Bag.” In Resuscitation, 62:319–320. Resuscitation.
APA
De Regge, M., Vogels, C., Calle, P., & Monsieurs, K. (2004). Retention of ventilation skills by emergency nurses three months after training: SMART bag compared with standard bag. RESUSCITATION (Vol. 62, pp. 319–320). Presented at the 7th Scientific congress of the European Resuscitation Council, Resuscitation.
Vancouver
1.
De Regge M, Vogels C, Calle P, Monsieurs K. Retention of ventilation skills by emergency nurses three months after training: SMART bag compared with standard bag. RESUSCITATION. Resuscitation; 2004. p. 319–20.
MLA
De Regge, Melissa, Catherine Vogels, Paul Calle, et al. “Retention of Ventilation Skills by Emergency Nurses Three Months After Training: SMART Bag Compared with Standard Bag.” Resuscitation. Vol. 62. Resuscitation, 2004. 319–320. Print.