Utility of the SotairTM Device in Manual Ventilation of Different Lung Compliances

Abstract Background: During positive pressure ventilation, peak inspiratory pressure (PIP) and Tidal Volume (TV) must be kept at optimal levels to achieve appropriate ventilation without causing complications, such as trauma to the lung parenchyma or stomach insufflation. Manual ventilation using a Bag-valve-mask (BVM) results in highly variable TVs and PIPs that could increase the risk of volutrauma and barotrauma. It is unknown whether pathologic changes in lung compliance alter the TV and PIP during manual ventilation. Methods: This study used a lung simulator and volunteer medical students, medics and nurses to assess whether the pressure and flow limiting SotairTM device resulted in more appropriate TVs and PIPs during manual ventilation compared to BVM only, using a mechanical ventilator as the standard. The secondary aim was to determine whether decreased lung compliance, which simulates the physiology of lungs with Acute Respiratory Distress Syndrome (ARDS), affected the conclusion. Results: We found that the SotairTM device helped maintain PIP and TV closer to mechanical ventilator baseline levels than BVM only ventilation across lung compliance settings. The SotairTM device also helped providers maintain PIP levels below the threshold of pressures known to cause gastric insufflation and barotrauma. Conclusions: This data indicates that manual ventilation using the SotairTM device is a safer option than unmitigated BVM only ventilation in both normal and decreased lung compliance conditions.