Simulation study for Bag-Valve-Mask application guideline on pathologic pulmonary condition

모형폐의 물리적 특성 변화에 따른 Bag-Valve-Mask의 사용방법 연구

  • Choi, Hae-Kyung (Department of Emergency Medical Services, Eulji University) ;
  • Jung, Hyung-Keon (Department of Emergency Medical Services, Eulji University)
  • 최혜경 (을지대학교 응급구조학과) ;
  • 정형근 (을지대학교 응급구조학과)
  • Received : 2013.10.10
  • Accepted : 2013.12.17
  • Published : 2013.12.31


Purpose: The purpose of this study is to get basic user guidelines of safe and efficient bag-valve-mask application on patients having abnormal pathophysiological pulmonary conditions. Methods: This study was performed by pre-qualified 35 EMS junior and senior students. Participants were instructed to compress ambulatory bag randomly about half, one-third, one-fourth within different airway resistance and pulmonary compliance. Resultant tidal volume and pulmonary wedge pressures on RespiTranier monitor were analysed in relation to pulmonary physiologic index. Results: At least over half compression of bag guaranteed minimal tidal volume regardless of pulmonary conditions. There was no increase of pulmonary wedge pressure above the level of barotrauma on half compression at any pulmonary conditions. Conclusion: Assisted ventilation with ambulatory bag on patients with pathological pulmonary conditions should be over half compressed regardless of respiratory disease entity.


Airway resistance;Barotrauma;Pulmonary compliance;Pulmonary wedge pressure;Tidal volume


  1. Nolan JP, Soar J. Airway techniques and ventilation strategies. Curr Opin Crit Care 2008;14(3):279-86.
  2. Sim GS, Kim EM. Advanced airway management for the prehospital traumatic. J Korea Academia-Industrial Cooperation Society 2013;14(5):2360-67.
  3. Strote J, Roth R, Cone DC, Wang HE. Prehospital endotracheal intubation; the controversy continues. Am J Emerg Med 2009;27(9):1142-7.
  4. Jacobs LM, Berrizbeitia LD, Bennet B, Madigan C. Endotracheal intubation in the prehospital phase of emergency medical care. JAMA 1983;250(16):2175-7.
  5. Egly J, Custodio D, Bishop V, Prescott M, Lucia V, Jackson RE, et al. Assessing the impact of prehospital intubation on survival in out-of-hospital cardiac arrest. Prehospi Emerg Care 2010;15(1): 44-9.
  6. Katz SH, Falk JL. Misplaced endotracheal tube by paramedics in an urban emergency medical service system. Ann Emerg Med 2001;37(1):32-7.
  7. Christensen EF, HOyer CC. Prehospital tracheal intubation in severely injured patients: a Danish observational study. BMJ 2003;327(7414):533-4.
  8. Cho SM, Jung HK. Differentiation of tidal volume & mean airway pressure with different Bag-Valve-Mask compression depth and compression rate. Korean J Emerg Med Ser 2012;16:67-74.
  9. Lim JS, Cho YC, Kwon OY, Chung SP, Yu K, Kim SW. Precise minute ventilation deliverly using a Bag-Valve-Mask and audible feedback. Am J Emerg Med 2012;30(7): 1068-71.
  10. Her C, Cerabona T, Baek SH, Shin SW. Increased pulmonary resistance in morbidly obese patients without daytime hypoxia: clinical utility of the pulmonary artery catheter. Anesthesiology 2010;113(3): 552-9.
  11. Mahajan A, Hoftman N, Hsu A, Schroeder R, Wald S. Continuous monitoring of dynamic pulmonary compliance enables detection of endobronchial intubation in infants and children. Anesth Analg 2007; 105(1):51-6.
  12. Kim MS, Cho YJ, Moon HB, Cho SH. Factors for poor prognosis of near-fatal asthma after recovery from a life threatening asthma attack. Korean J Intern Med 2008; 23(4):170-5.
  13. Weiss ST, Horner A, Shapiro G, Sternberg AL. The prevalence of environmental exposure to perceived asthma triggers in children with mild-to-moderate asthma: data from the childhood asthma management program(CAMP). J Allergy Clin Immunol 2001;107(4):634-40.
  14. Kane C, Galanes S. Adult Respiratory Distress Syndrome. Crit Care Nurs Q 2004; 27(4):325-35.