Exploring the potential impact of real-time ventilation feedback on the quality of manual bag ventilation in routine ICU practice. The FEED-BAG study

BACKGROUND: Manual bag ventilation is a routine procedure in the intensive care unit. It is neither simple nor free from adverse events. OBJECTIVE: To compare standard manual ventilation with ventilation guided by a ventilation feedback device in terms of bag ventilation delivery by intensive care unit clinicians. METHODS: ) within the target range. RESULTS: Fifty-three intensive care unit clinicians performed, in total, 106 manual ventilation trials: 53 unguided and 53 ventilation feedback device-guided. Under unguided conditions, intensive care unit clinicians failed to deliver standard manual ventilation within the appropriate parameters, with both tidal volume and ventilation rate falling outside the target range. Ventilation performance improved during ventilation feedback device-guided trials, with both tidal volume and minute ventilation fell significantly more frequently within the target range (p < 0.001). In patients with pulmonary pathology, ventilation feedback device guidance was associated with significantly lower ventilation rate (p = 0.02) and minute ventilation (p < 0.001). CONCLUSIONS: Without real-time feedback, intensive care unit clinicians appear unable to deliver optimal ventilation when performing usual-care standard manual ventilation. IMPLICATIONS FOR CLINICAL PRACTICE: The use of a hand-held portable ventilation feedback device may help to improve manual bag ventilation at bedside.