Artificial ventilation during transport: A randomized crossover study of manual resuscitators with comparison to mechanical ventilators in a simulation model
Bibliographic record
Abstract
Abstract Background Positive‐pressure ventilation in critically ill patients is commonly administered via a manual resuscitation device or a mechanical ventilator during transport. Our group previously compared delivered ventilation parameters between a self‐inflating resuscitator and a flow‐inflating resuscitator during simulated in‐hospital pediatric transport. However, unequal group access to inline pressure manometry may have biased our results. In this study, we examined the performance of the self‐inflating resuscitator and the flow‐inflating resuscitator, both equipped with inline manometry, and several mechanical ventilators to deliver prescribed ventilation parameters during simulated pediatric transport. Methods Thirty anesthesia providers were randomized to initial resuscitator device used to hand ventilate a test lung. The resuscitators studied were a Jackson‐Rees circuit (flow‐inflating resuscitator) or a Laerdal pediatric silicone resuscitator (self‐inflating resuscitator), both employing manometers. The scenario was repeated using several mechanical transport ventilators (Hamilton‐T1, LTV® 1000, and LTV® 1200). The primary outcome was the proportion of total breaths delivered within the predefined target PIP/PEEP range (30 ± 3, 10 ± 3 cm H2O). Results The Hamilton‐T1 outperformed the other ventilators for breaths in the recommended range (χ2 = 2284, df = 2, P < .001) and with no breaths in the unacceptable range (χ2 = 2333, df = 2, P < .001). Hamilton‐T1 also outperformed all human providers in proportion of delivered acceptable and unacceptable breaths (χ2 = 4540, df = 3, P < .001 and χ2 = 639, df = 3, P < .001, respectively). Compared with the flow‐inflating resuscitator, the self‐inflating resuscitator was associated with greater odds of breaths falling outside the recommended range (Odds ratio (95% CI): 1.81 (1.51‐2.17)) or unacceptable (Odds ratio (95% CI): 1.63 (1.48‐1.81)). Conclusion This study demonstrates that a majority of breaths delivered by manual resuscitation device fall outside of target range regardless of provider experience or device type. The mechanical ventilator (Hamilton‐T1) outperforms the other positive‐pressure ventilation methods with respect to delivery of important ventilation parameters. In contrast, 100% of breaths delivered by the LTV 1200 were deemed unacceptable.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".