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Gerstein NS, Braude DA, Petersen TR, Goumas A, Fish AC. Use of Transparent Film Dressing to Facilitate Mask Ventilation in Bearded Patients. J Emerg Med 2024; 66:163-169. [PMID: 38238230 DOI: 10.1016/j.jemermed.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/16/2023] [Accepted: 07/15/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mask ventilation is a critical airway procedure made more difficult in the bearded patient. OBJECTIVE We sought to objectively investigate whether application of transparent cling film (TegadermTM; 3M Healthcare, Maplewood, MN) over a beard in the operating room improves the quality of mask ventilation. METHODS This was a randomized crossover trial of bearded adult patients undergoing surgery. Exclusions included emergency procedures, American Society of Anesthesiologists physical status classification > 3, a documented history of difficult mask ventilation, and body mass index (BMI) > 50. Transparent cling film was applied snuggly over the lower face with a 2- to 3-cm slit cut over the mouth after anesthesia induction. Mask ventilation performed by an anesthesiology resident, anesthesiology assistant, or anesthesiology assistant student and standardized to a thenar-eminence grip without use of airway adjuncts in a sniffing position. Standardized pressure-controlled ventilations were delivered via an anesthesia machine. A calibrated external pneumotachograph was used to measure delivered and returned tidal volumes from which raw and percent air leak were calculated. A clinically significant difference was determined a priori to be 15%, necessitating the enrollment of 25 patients. RESULTS Of 25 subjects, 96% were men with a mean ± SD BMI of 29.3 ± 6. Seventeen (68%) had a full beard and 8 (32%) had a partial beard. The mean ± SD leakage was 48% ± 26% for transparent cling film vs. 46% ± 20% without its application, which was not significantly different (p = 0.67). CONCLUSIONS The use of transparent cling film to cover the lower half of the bearded face did not have an impact on the ability or efficacy to perform mask ventilation in the operating room setting. CLINICALTRIALS gov, Number NCT04274686.
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Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Darren A Braude
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; Departments of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Timothy R Petersen
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; Department of Obstetrics and Gynecology, Office of Graduate Medical Education, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Andrew Goumas
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Adam C Fish
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Gavish L, Firman S, Barrantes RAG, Erport A, Shapiro J, Mimouni C, Velitsky D, Eisenkraft A, Gertz SD, Pizov R. Pre-intubation ventilation device for bearded patients: prospective, randomized, crossover trial in anesthetized patients. Intern Emerg Med 2023; 18:559-566. [PMID: 36746888 DOI: 10.1007/s11739-023-03211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/21/2023] [Indexed: 02/08/2023]
Abstract
Having a beard is an independent predictor of difficult ventilation by face mask. This study evaluates the efficacy of a novel intra-oral Bag-Valve-Guedel Adaptor (BVGA) in anaesthetized bearded patients. Patients with ASA score 1-2, scheduled for elective surgery, were recruited for this prospective, crossover trial. Beard length was categorized as < 0.5 cm, 0.5-1 cm, 1-5 cm, or > 5 cm. Patients were ventilated by attending anesthesiologists using the BVGA and a facemask (both with a Guedel oral airway). End-tidal CO2 (EtCO2) and expiratory tidal volume (TV) were recorded as was the number of hands required for the procedure. The primary outcome was the difference between BVGA and Facemask. Sixty-one patients were enrolled. Of these, 38 had beards, and 23 were without beards or with beards < 0.5 cm length. In bearded patients, ventilation with the BVGA was superior to the face mask by EtCO2 and non-inferior by TV (BVGA-vs-Mask, mean [95% CI]: EtCO2 [mmHg], 33.0 [31.6, 34.3]-vs-27.2 [25.5, 28.8], p < 0.001; TV [ml∙kg-1 IBW], 8.1 [7.4, 8.9]-vs-6.9 [6.0, 7.7], p = 0.11). The BVGA was found to be superior to the face mask by EtCO2 across all beard lengths (p ≤ 0.001), but by TV only for the longest beard group (p = 0.009). After securing the BVGA, ventilation was possible without hands in 74% of the cases - clearly impossible with the facemask (p ≤ 0.001). The BVGA is more effective and more convenient than the facemask in anaesthetized bearded patients. A follow-up study is underway to test whether replacing the face mask with the BVGA will improve effectiveness and ease of pre-intubation field ventilation by less-experienced, first responders.
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Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel.
- The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Shimon Firman
- Department of Anesthesiology, Critical Care and Pain Medicine, Hebrew University-Hadassah School of Medicine, Hadassah-Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - Roger Andres Gomez Barrantes
- Department of Anesthesiology, Critical Care and Pain Medicine, Hebrew University-Hadassah School of Medicine, Hadassah-Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - Angelika Erport
- Department of Anesthesiology, Critical Care and Pain Medicine, Hebrew University-Hadassah School of Medicine, Hadassah-Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - Joel Shapiro
- Department of Anesthesiology, Critical Care and Pain Medicine, Hebrew University-Hadassah School of Medicine, Hadassah-Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - Chloe Mimouni
- Department of Anesthesiology, Critical Care and Pain Medicine, Hebrew University-Hadassah School of Medicine, Hadassah-Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - Dina Velitsky
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - Arik Eisenkraft
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - S David Gertz
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reuven Pizov
- Department of Anesthesiology, Critical Care and Pain Medicine, Hebrew University-Hadassah School of Medicine, Hadassah-Hebrew University Medical Center Jerusalem, Jerusalem, Israel
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W Lyng J, Guyette FX, Levy M, Bosson N. Prehospital Manual Ventilation: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:23-31. [PMID: 35001826 DOI: 10.1080/10903127.2021.1981506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Manual ventilation using a self-inflating bag device paired with a facemask (bag-valve-mask, or BVM ventilation) or invasive airway (bag-valve-device, or BVD ventilation) is a fundamental airway management skill for all Emergency Medical Services (EMS) clinicians. Delivery of manual ventilations is challenging. Several strategies and adjunct technologies can increase the effectiveness of manual ventilation. NAEMSP recommends:All EMS clinicians must be proficient in bag-valve-mask ventilation.BVM ventilation should be performed using a two-person technique whenever feasible.EMS clinicians should use available techniques and adjuncts to achieve optimal mask seal, improve airway patency, optimize delivery of the correct rate, tidal volume, and pressure during manual ventilation, and allow continual assessment of manual ventilation effectiveness.
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