New ambu bag

[GaseousClay]

Have you guys seen the ambu bags with the small plastic reservoir bag at the end of it? Is that for allowing for spontaneous ventilation vs the old ambu that only delivered air when squeezing?

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[Iso4ane]

Have you guys seen the ambu bags with the small plastic reservoir bag at the end of it? Is that for allowing for spontaneous ventilation vs the old ambu that only delivered air when squeezing?

My understanding of it is it similar to the difference between a non-rebreather and a simple face mask. The bag is a reservoir for air and allows you to deliver higher FiO2.

 

[deleted162650]

You can breath spontaneously through any ambu bag

 

[GaseousClay]

You can breath spontaneously through any ambu bag

thats what I was telling everyone and they insist that the regular ambu does not allow for spontaneous ventilation, so i just went with it. this new bag i can clearly see inflating and deflating with ventilation.

 

[GaseousClay]

Spontaneous ventilation

• Adminstered FiO2 during spontaneous ventilation can vary greatly between devices
  • Laerdal: FiO2 0.96
  • Hsiner: FiO2 0.75
  • Mayo: FiO2 0.55
• sufficient negative inspiratory pressure is required to overcome the patient inspiratory valve, otherwise, air will be entrained instead of oxygen
  • some duckbill valves are difficult to overcome when spontaneously breathing
  • patients with reduced respiratory effort are particularly at risk
• As a safeguard in spontaneously breathing patients it is useful to coordinate ‘assist’ positive pressure ventilation with the patient’s spontaneous efforts to ensure that the patient inspiratory valve is opening

 

[deleted162650]

thats what I was telling everyone and they insist that the regular ambu does not allow for spontaneous ventilation, so i just went with it. this new bag i can clearly see inflating and deflating with ventilation.

They’re all idiots. Next time pull one out and show ‘em. Good points in your last post.

 

[chocomorsel]

You can breath spontaneously through any ambu bag

I have had some RTs insist that this is not the case, and they insist that the bag has to be squeezed. Well, how come I can feel the flow of oxygen without having to squeeze the bag then?
Where do they learn this?

 

[norski]

I have had some RTs insist that this is not the case, and they insist that the bag has to be squeezed. Well, how come I can feel the flow of oxygen without having to squeeze the bag then?
Where do they learn this?

Newbies where I work aren't allowed to do BVM on anyone if they haven't been subjected to it themselves. And shock, horror, they can breathe! We use almost exclusively Lærdals, but there are a few Ambus lying around as well (crit care nurse, Norway).

 

[MoMoGesiologist]

You can breath spontaneously through any ambu bag

I thought AMBU had a one way valve making it difficult to inspire through?

 

[deleted162650]

I thought AMBU had a one way valve making it difficult to inspire through?

Try it and get back to me. The same valve that opens when you squeeze the bag will open when you inhale from the other side. The valve opens in response to a pressure differential across it. It doesn’t know if that’s from positive pressure on one side or negative pressure on the other.

 

[Hamhock]

Try it and get back to me. The same valve that opens when you squeeze the bag will open when you inhale from the other side. The valve opens in response to a pressure differential across it. It doesn’t know if that’s from positive pressure on one side or negative pressure on the other.

Yes, and herein the confusion between disciplines and specialties is found.

The most commonly found "Ambu bag" (in my multi-hospital and multi-region experience) has a one-way valve requiring sufficient negative inspiratory pressure from the patient or some positive pressure from the provider.
The typical "ambu-bag" is NOT like a Jackson.

This conflict/confusion arises most often when the 'expert' anesthesiologist arrives urgently in the ED or ICU and immediately removes the NRB before RSI in favor of the "ambu" (it's even worse when BiPap is removed in favor of "ambu").

Most anesthesiologists are better at making a tight seal, which is typically great. However, if the patient has only agonal/weak ventilatory effort or has recently received sedation (even ketamine dissociation), this great seal is basically asphyxiating the patient (certainly not pre-oxygenating/de-nitro).

HH

 

[GaseousClay]

Yes, and herein the confusion between disciplines and specialties is found.

The most commonly found "Ambu bag" (in my multi-hospital and multi-region experience) has a one-way valve requiring sufficient negative inspiratory pressure from the patient or some positive pressure from the provider.
The typical "ambu-bag" is NOT like a Jackson.

This conflict/confusion arises most often when the 'expert' anesthesiologist arrives urgently in the ED or ICU and immediately removes the NRB before RSI in favor of the "ambu" (it's even worse when BiPap is removed in favor of "ambu").

Most anesthesiologists are better at making a tight seal, which is typically great. However, if the patient has only agonal/weak ventilatory effort or has recently received sedation (even ketamine dissociation), this great seal is basically asphyxiating the patient (certainly not pre-oxygenating/de-nitro).

HH

It is better than the NRB when you have a great seal and give assisting positive pressure with these agonal breaths. But yes when you just try to let them breathe with it on their face its not very favorable neither are when the RTs jam like 30 breaths/min full force and put so much air in the stomach they are sure to spew out any gastric contents.

 

[migm]

Is the issue that the bag is literally suffocating if unable to overcome the valve? In addition is there another issue where air is entrained into inspiration lowering delivered FiO2? I've read both. https://d1jhm577bx9zey.cloudfront.n...suscitator/Khoury-Resuscitator-PUB-000560.pdf

 

[anbuitachi]

this may be dependent on the brand and type/generation of the bags.

we use the portex adult resuscitator BVM. it has a soft duck bill valve on it that opens with inspiration and bagging. expiration is thru the flow diverter. it felt pretty easy to me to overcome a duckbill valve. i didnt really notice any different but then again im not in respiratory failure.

 

[woopedazz]

Are you guys telling me that in the US the ambu bags don't have a reservoir attached?

Does your wall O2 flow rate run at 100L/min to prevent entrainment and rebreathing?

EDIT: Nevermind, I see we're discussing spont vs IPPV. I thought both are equally a bit crap through the Mapleson C circuits?