Resuscitation Breathing Systems

RESUSCITATION BREATHING SYSTEMS

Resuscitation bags (AMBU bags or bag-mask units) are commonly used for emergency ventilation because of their simplicity, portability, and ability to deliver almost 100% oxygen (Figure 3–11).

A resuscitator is unlike a Mapleson circuit or a circle system because it contains a nonrebreathing valve. (Remember that a Mapleson system is considered valveless even though it contains an APL valve, whereas a circle system contains unidirectional valves that direct flow through an absorber but allow rebreathing of exhaled gases.)

High concentrations of oxygen can be delivered to a mask or tracheal tube during spontaneous or controlled ventilation if a source of high fresh gas flow is connected to the inlet nipple. The patient valve opens during controlled or spontaneous inspi-ration to allow gas flow from the ventilation bag to the patient. Rebreathing is prevented by venting exhaled gas to the atmosphere through exhalation ports in this valve. The compressible, self-refilling ventilation bag also contains an intake valve. This valve closes during bag compression, permitting positive-pressure ventilation. The bag is refilled by flow through the fresh gas inlet and across the intake valve. Connecting a reservoir to the intake valve helps prevent the entrainment of room air. The reservoir valve assembly is really two unidirectional valves: the inlet valve and the outlet valve. The inlet valve allows ambient air to enter the ventilation bag if fresh gas flow is inadequate to maintain reservoir filling. Positive pressure in the reservoir bag opens the outlet valve, which vents oxygen if fresh gas flow is excessive.

There are several disadvantages to resuscitator breathing systems. First, they require high fresh gas flows to achieve a high Fio₂. Fio₂ is directly pro-portional to the oxygen concentration and flow rate of the gas mixture supplied to the resuscitator (usually 100% oxygen) and inversely proportional to the minute ventilation delivered to the patient. For example, a Laerdal resuscitator equipped with a res-ervoir requires a flow of 10 L/min to achieve an inspired oxygen concentration approaching 100% if a patient with a tidal volume of 750 mL is ventilated at a rate of 12 breaths/min. The maximum achievable tidal volumes are less than those that can be achieved with a system that uses a 3-L breathing bag. In fact, most adult resuscitators have a maximum tidal vol-ume of 1000 mL, which is sufficient for the lower tidal volumes generally employed in patient management. Finally, although a normally functioning patient valve has low resistance to inspiration and expiration, exhaled moisture can cause valve sticking.