The Pitfalls of Using Pop-Off Valves in Adult Emergency Airway

Area of Science:

• Emergency Medicine
• Critical Care
• Respiratory Physiology

Background:

• Positive-pressure relief valves, or "pop-off" valves, are common in pediatric airway equipment and are also found on some adult resuscitator bags.
• While designed to reduce barotrauma, these valves can limit delivered airway pressure during manual ventilation.
• In adult patients with high airway pressures, open pop-off valves can lead to hypoventilation and hypoxemia.

Purpose of the Study:

• To highlight the potential dangers of pop-off valves on adult resuscitator bags in emergency settings.
• To emphasize the importance of staff awareness regarding equipment changes and their potential impact on patient care.
• To inform emergency physicians about the risks associated with open pop-off valves in patients requiring high airway pressures.

Main Methods:

• Retrospective review of three adult cases in the emergency department following the unannounced introduction of new resuscitator bags with pop-off valves.
• Clinical observation of patient outcomes related to ventilation and oxygenation before and after identifying and disabling the pop-off valves.

Main Results:

• Three adult patients experienced hypoventilation and hypoxemia due to open pop-off valves on new resuscitator bags.
• These adverse events occurred in patients with both medical and traumatic pathologies.
• Disabling the pop-off valves led to significant improvements in patient ventilation and oxygenation.

Conclusions:

• Unannounced changes in airway equipment can be dangerous and lead to adverse patient outcomes.
• Open pop-off valves on resuscitator bags can cause inadequate ventilation and hypoxemia in patients with high airway pressures, without providing tactile feedback.
• Emergency physicians should be vigilant about equipment changes and proactively disable pop-off valves on resuscitator bags to ensure optimal patient care.