Evaluation of manual resuscitators used in ICUs in
               Brazil

Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (V_T) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria.

RESULTS:

Expiratory resistance was greater than 6 cmH₂O . L⁻¹ . s⁻¹ in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH₂O), and the maximal pressure was 32.0-55.9 cmH₂O. Mean V_T varied greatly among the MRs tested. The mean V_T values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean V_T was generally lower from the Brazilian-made MRs that had a pressure-limiting valve.

CONCLUSIONS:

The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower V_T values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible.

Materials testing; Positive-pressure respiration; Equipment safety; Equipment design; Respiration, artificial; Resuscitation

Manual resuscitator	Type de valve	Type of bag	Capacity of the bag, mL	Pressure-limiting valve, cmH₂O	Unidirectional inspiratory valve	Patient connection port
1. Ambu Silicone Resuscitator	diaphragm	silicone	1,500	-	yes	360° swivel
2. Ambu SPUR	diaphragm	silicone	1,500	-	yes	360° swivel
3. Hudson RCI Lifesaver	duckbill	silicone	1,600	-	yes	360° swivel
4. J.G. Moriya	diaphragm	silicone	1,700	40 ± 5 up to 75	yes	fixed
5. Oxigel	spring and disk	vinyl	1,200	40	yes	fixed
6. Protec Basic Silicone	diaphragm	silicone	1,600	35-45	yes	fixed
7. RWR	duckbill	silicone	2,500	35-45	yes	fixed
8. Unitec	diaphragm	vinyl	1,000	ND	yes	fixed

Manual resuscitator	Inspiratory resistance, cmH₂O . L⁻¹ . s⁻¹	Expiratory resistance, cmH₂O . L⁻¹ . s⁻¹	Limiting valve: opening pressure/maximal pressure, cmH₂O
1. Ambu	2.96	3.29	N/A
2. Ambu Spur	-	3.17	N/A
3. Hudson/RCI	3.16	4.42	N/A
4. Moriya	2.11	3.08	16.6/55.9
5. Oxigel	5.69	3.69	13.4/37.6
6. Protec	2.77	7.91	7.2/33
7. RWR	2.66	3.62	6.1/32
8. Unitec	1.54	1.75	14.6/47.3

Condition	Manual resuscitator
Condition	Ambu	Ambu S	Hudson/RCI	Moriya	Oxigel	Protec	RWR	Unitec
ASTM condition^b
V_T with the one-handed technique	537 ± 81	525 ± 99	519 ± 98	493 ± 71	468 ± 55	430 ± 70^,^,**	487 ± 85	317 ± 49^,^,**
V_T with the two-handed technique	694 ± 78	694 ± 51	658 ± 108	637 ± 72	509 ± 62 ^,^,**	511 ± 58^,^,**	577 ± 78	417 ± 45^,^,**
Normal condition^c
V_T with the one-handed technique	621 ± 107	631 ± 92	570 ± 87*	526 ± 57^,*	533 ± 85 ^,*	506 ± 60^,^,**	550 ± 100^,^,**	387 ± 55^,^,**
V_T with the two-handed technique	760 ± 114	804 ± 105	710 ± 86	666 ± 67**	650 ± 45**	588 ± 38^,^,**	697 ± 97	511 ± 67^,^,**

Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[1] Correspondence to: Mauro R. Tucci. Laboratório de Pneumologia LIM09, Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Arnaldo, 455, Sala 2144, 2º andar, CEP 01246-903, São Paulo, SP, Brasil. Tel. 55 11 3061-7361. Fax: 55 11 3061-2492. E-mail: mrotucci@gmail.com

Brasil

Brasil

Evaluation of manual resuscitators used in ICUs in Brazil* * Study carried out in Laboratório de Investigação Médica 09 (LIM09, Laboratory for Medical Research 09), specializing in Pulmonology, University of São Paulo School of Medicine, São Paulo, Brazil.

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Evaluation of manual resuscitators used in ICUs in Brazil^* * Study carried out in Laboratório de Investigação Médica 09 (LIM09, Laboratory for Medical Research 09), specializing in Pulmonology, University of São Paulo School of Medicine, São Paulo, Brazil.