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OUTCOME OF BAG-VALVE MASK (BVM) VENTILATION PERFORMED BY MEDICAL HOUSE STAFF TRAINED USING A COMPUTERIZED PATIENT SIMULATOR (CPS) WITH SCENARIO-BASED TRAINING (SBT) DURING EMERGENCY ENDOTRACHEAL INTUBATION (EEI)

Beth Israel Medical Center, New york, NY

PURPOSE: Adequate preoxygenation prior to intubation decreases the risk of desaturation during subsequent intubation attempt. We examined whether CPS with SBT is effective in training housestaff to provide adequate preoxygenation during EEI.

METHODS: In July 2005, Post-Graduate Year 1(PGY1) internal medicine housestaff received intensive training in BVM technique using CPS with SBT. They were assigned to provide BVM ventilation during EEI performed in the MICU. Adequacy of BVM ventilation was measured for 101 EEI during a 10 month period. Data was obtained from printouts of continuous saturation monitoring and from digital voice recording of the procedure. Starting in the 5th month of the study, the BVM crew used a 10cm H20 Positive End-Expiratory (PEEP) valve attached to the BVM.

RESULTS: Before deep sedation for EEI, all patients were on high flow FI02 1.0 via face mask in order to achieve maximal preoxygenation. Despite this, a subgroup of patients (19/101) had severe desaturation (< 80% saturation) prior to initiation of deep sedation required for endotracheal intubation. Following deep sedation, the BVM crew achieved saturation >90% in 87/101 cases. In patients with severe desaturation before sedation, the BVM crew was able to achieve a saturation >90% in 14/19 of cases. Before use of the PEEP valve, 4/8 patients with severe initial desaturation could be resaturated to >90%; with the PEEP valve, 10/11 patients could be resaturated (p=0.046 by Chi-Square).

CONCLUSION: Medical housestaff trained using a CPS with SBT provided effective preoxygenation during EEI. Housestaff using a PEEP valve attached to the BVM were significantly more likely to achieve saturation values greater than 90% in a subgroup of patients who failed to resaturate with high flow FI02 1.0 via face mask before sedation.

CLINICAL IMPLICATIONS: SBT with CPS is recommended as a training method to ensure housestaff skill in BVM ventilation during actual clinical events. A PEEP valve attached to the BVM is helpful in achieving resaturation during EEI.

DISCLOSURE: Abhijith Hegde, No Financial Disclosure Information; No Product/Research Disclosure Information