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Updated: Apr 24, 2026
Mechanical Ventilation Boot Camp Curriculum
Published on: March 12, 2018
Exploring the potential impact of real-time ventilation feedback on the quality of manual bag ventilation in routine
Emilio Rodriguez-Ruiz1, Maitane Campelo-Izquierdo2, Ana Estany-Gestal3
1Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
Background:
Manual bag ventilation is a routine procedure in the intensive care unit. It is neither simple nor free from adverse events.
Objective:
To compare standard manual ventilation with ventilation guided by a ventilation feedback device in terms of bag ventilation delivery by intensive care unit clinicians.
Methods:
In this quasi-experimental study with non-concurrent controls intensive care unit clinicians delivered usual-care manual bag ventilations via an endotracheal tube to adult mechanically ventilated patients without or with non-severe respiratory pathology. Each participant performed one unguided trial and one ventilation feedback device-guided trial. The variables analysed were median tidal volume, median minute ventilation, and median ventilation rate. Adequate ventilation performance was defined as a median tidal volume (4-8 mL/Kg predicted body weight) and a median ventilation rate (8-13 min-1) within the target range.
Results:
Fifty-three intensive care unit clinicians performed, in total, 106 manual ventilation trials: 53 unguided and 53 ventilation feedback device-guided. Under unguided conditions, intensive care unit clinicians failed to deliver standard manual ventilation within the appropriate parameters, with both tidal volume and ventilation rate falling outside the target range. Ventilation performance improved during ventilation feedback device-guided trials, with both tidal volume and minute ventilation fell significantly more frequently within the target range (p < 0.001). In patients with pulmonary pathology, ventilation feedback device guidance was associated with significantly lower ventilation rate (p = 0.02) and minute ventilation (p < 0.001).
Conclusions:
Without real-time feedback, intensive care unit clinicians appear unable to deliver optimal ventilation when performing usual-care standard manual ventilation.
Implications For Clinical Practice:
The use of a hand-held portable ventilation feedback device may help to improve manual bag ventilation at bedside.
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