Quality of Bag-Mask Ventilation for Children Before Intubation: Single-Center PICU Pilot Observational Study,...

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Airway Management

Background:

• Bag-mask ventilation (BMV) is a critical intervention before tracheal intubation in pediatric intensive care units (PICUs).
• The quality of BMV can significantly impact patient outcomes, yet it is often poorly characterized.

Purpose of the Study:

• To assess the quality of bag-mask ventilation (BMV) in children prior to tracheal intubation in a PICU setting.
• To determine the association between low-quality BMV and adverse airway outcomes.

Main Methods:

• A single-center, pilot observational study conducted from 2019-2022 in a quaternary care PICU.
• Respiratory function monitor data (flow, pressure) were collected from 8446 BMV breaths in 85 pediatric patients.
• Low-quality BMV was defined by criteria including inadequate/excessive tidal volume, high peak inspiratory pressure, excessive mask leak, or failure to relieve obstruction.

Main Results:

• 78% of BMV breaths exhibited at least one low-quality criterion, most commonly inadequate/excessive exhaled tidal volume (55.5%) and excessive mask leak (46.2%).
• Infants and young children (<7 years) had a higher proportion of low-quality BMV breaths compared to older children.
• Low-quality BMV was significantly associated with a 2.8-fold increased odds of adverse airway outcomes (e.g., intubation-associated events, desaturation).

Conclusions:

• The majority of BMV breaths delivered in this PICU population were of low quality.
• Younger children were more likely to receive low-quality BMV.
• Poor BMV quality is a significant risk factor for adverse airway outcomes in pediatric patients requiring intubation.