Using Collapased Adult BVM for Children or Infants

ThadeusJ

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Need some help from the professionals here. I have heard of people using a collapsed adult BVM for use on children and/or infants in order to obtain a smaller tidal volume. As a clinician, I never needed it as we always had a supply of proper sized units. For the life of me, I don't know the best search terms to use, although I have heard of it years ago and recently again (so someone must know about it).

Has anyone else heard f this and if so, is there an official reference or study that can confirm its efficacy?

Much obliged.
 

CbrMonster

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Why would you collapse it? Just bag until you see visible chest rise and release bag to appropriate rate per minute. It’s essentially like an adult giving mouth to mouth to a child you breathe into the patient until you see visible chest rise.
 

PotatoMedic

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Because EMS providers are horrible at using a bvm. We regularly over ventilate our patients. Our agency just went to bvms with a volume of 700ml, integrated peep and manometer.
 

johnrsemt

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Had a flight medic suggest using a peds BVM on adults due to not over bagging adults.
But the reverse is a bad, BAD idea
 

DesertMedic66

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Why would you collapse it? Just bag until you see visible chest rise and release bag to appropriate rate per minute. It’s essentially like an adult giving mouth to mouth to a child you breathe into the patient until you see visible chest rise.
On a 30 minute transport you are not going to have someone who will be 100% focused on the chest for 100% of the transport time.

The average Vt of an adult sized BVM is 1475mL. You would need a 7’6” patient who you are ventilating at 12mL/kg of IBW to get around that number. With that much extra mL in the BVM it can be very easy to not pay attention and give way too much. Yes you could squeeze the BVM 1/3 but that is hard to judge as you are squeezing and hard to keep consistent. By keeping the bottom part of the BVM folded in you are reducing the Vt that the BVM can hold which will make it less likely to give your patient too much. You could also use one hand to squeeze the bag however there are huge differences between hand sizes that can make a huge difference.

There are some systems that I have heard about and a decent amount of systems who are talking about removing the adult BVM and only using a pediatric BVM.
 

E tank

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Because EMS providers are horrible at using a bvm. We regularly over ventilate our patients. Our agency just went to bvms with a volume of 700ml, integrated peep and manometer.
Probably the best solution. bvm units have historically been too big because they conform to the archaic conventional wisdom of larger rather than smaller tidal volumes. The manufacturing just hasn't caught up with current thinking on mechanical ventilation. And I wouldn't Macgyver an adult bag to suit a pediatric patient. If I had to use a big bag on a little person, I'd watch chest rise and make sure I had a huge leak.
 

ThadeusJ

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Thank you all for your comments as this suggestion has perplexed me. As a matter of reference (and for full disclosure) I work with a BVM designer and manufacturer (plus a crapload of formal education and clinical experience, mind you):
  1. Our standard adult BVM has a volume of 1500 mL, single hand stroke volume of 850 mL, two hand stroke volume of 1150 mL;
  2. The child size has a volume of 900 mL, one hand stroke volume of 600 mL and two hand of 740 mL and;
  3. the infant unit has a volume of 320 mL, one hand stroke volume of 270 mL and two hand stroke volume of 310 mL.
  4. The smaller sizes have a 35 cmH2O pressure blowoff and we make an adult size with a blowoff as well.
I do agree that the sizes haven't reflected smaller volumes prescribed today. When I first got into the game, it was 10-12 mL/kg, while it's much smaller today. As a side note, the first article that popped up on Google was a study performed on dogs (for veterinarians) that advocated 15 mL/kg on CMV.
 

Remi

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I've never heard of it, and I'm having a hard time visualizing how that would even work.
 

DrParasite

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Come on, man...given the tools, we make it work!
You know, just because you CAN make it work, doesn't mean you SHOULD.

EMS (and much of public safety in general) has a habit of MacGyvering stuff to get it to work the way they want it. We can improvise a lot on the spot, and often justify doing so by saying do what is needed to get the job done. But in healthcare, using tools outside of how the manufacturer intended can put you in potentially murky legal waters (esp when something goes wrong), and realistically, shouldn't you have the right tools (with the right dimensions) to do the right job, vs having to shimmy something together to get it to do the job you want?

and I agree with @Remi, I can't visualize how this would work, and be used successfully to ventilate a patient.
 

Tigger

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I am not sure how much volume is reduced, but it is still an easy squeeze.
 

johnrsemt

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It would be an small easy squeeze, but it would worry me; cause it would be so easy to squeeze too hard and give an infant an pneumo with a too large of a squeeze. Much easier than doing it to an adult
 
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