Objective Different types of devices for manual (bag) ventilation are available. But which device is the best to use is still a matter of controversy. Most frequently used devices in Dutch PICU’s include the Self Inflating Bag (SIB) and the Flow Inflating Bag (FIB). The choice of the system seems to be subjective, and depend mostly on unit policy or personal preferences. Studies on manual ventilation in the paediatric population are scarce. We therefore conducted a prospective, observational study to compare both devices with regard to peak pressures generated and consequences on respiratory parameters during manual ventilation of intubated and mechanically ventilated children.

Setting A paediatric intensive care unit of an university hospital.

Patients Patients admitted to the PICU; intubated with tube size 3.0, 3.5 or 4 and mechanically ventilated were eligible for the study.

Interventions Manual ventilation was performed with two devices, a Laerdal Silicone paediatric circuit and a Mapleson C cirucuit. After inclusion, a tap was placed at the end of the manual inflation bag tube allowing for continuous pressure measurements during manual ventilation. Subjects were blinded to pressure recording and no feedback was provided. From each measurement a maximum peak pressure, mean peak pressure (+SD), median peak pressure and a frequency was calculated.

Results 412 measurements in 39 patients were performed (205/207). Both groups had significant higher peak pressures and median delivered pressure during manual ventilation (for both groups p = . 000) when compared to ventilator settings.

Discussion This study demonstrates that in order to perform MH in a safe and effective manner the pressures and volumes generated have to be monitored.