Comparison of automated and manual ventilation in a prehospital pediatric model

Portable transport ventilators (TV) and demand valves (DV) may be effective and easy-to-use alternatives to bag-valve (BV) for prehospital ventilation of adults. The purpose of the study was to determine whether such devices maintain arterial blood gases and airway pressures similar to those for BV in a pediatric swine model.

This study was a prospective, randomized, crossover design using immature swine (9.6 +/- 0.9 kg) to model ventilation in small children. Anesthetized, intubated, paralyzed, and cannulated animals were ventilated initially on standard mechanical hospital ventilation (HV). They were then assigned in random order to 10-minute intervals of ventilation using BV, TV, low-frequency jet ventilation (JV), and DV. Data were analyzed using repeated-measures ANOVA and Tukey multiple comparisons (alpha = 0.05).

The PaO2 exceeded 90 mm Hg for all animal/ventilation combinations. Blood PaCO2 was lower for BV and DV than it was for TV, JV, or HV. In contrast, blood pH was higher for BV and DV than it was for TV, JV, or HV. Peak airway pressure was higher for BV than it was for HV, TV, or JV; it was lower for JV than it was for HV, TV, or BV.

This animal model suggests that automated TV and JV may provide more effective ventilation of children than do manual BV or DV devices. Although promising, these findings require application in children under prehospital emergent conditions.