Quality of Bag-Mask Ventilation for Children Before Intubation: Single-Center PICU Pilot Observational Study, 2019-2022.

OBJECTIVES

To characterize the quality of bag-mask ventilation (BMV) before tracheal intubation in children in the PICU and to evaluate the association between poor BMV quality and adverse airway outcomes.

DESIGN

Single-center, pilot observational study, 2019-2022.

SETTING

Large, urban quaternary care PICU.

PATIENTS: Pediatric patients requiring BMV before tracheal intubation.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Using a respiratory function monitor, we collected flow and pressure data from 8446 BMV breaths before tracheal intubation in 85 children in the PICU (median age, 3.3 yr [interquartile range, 1.4-8.3 yr]). Adverse airway outcomes (i.e., tracheal intubation-associated event and/or pulse oximetry desaturation < 80%) occurred in 14 of 85 patients (16.5%). Low-quality BMV breaths were defined as: 1) inadequate or excessive exhaled tidal volume (VTe < 4 or > 12 mL/kg); 2) excessive peak inspiratory pressure (PIP) and excessive VTe; 3) excessive facemask leak (> 40%); or 4) failure to relieve upper airway obstruction. Overall, 78.0% of BMV breaths met at least one low-quality criterion; most frequently inadequate or excessive VTe (55.5%), followed by excessive leak (46.2%). Infants (< 1 yr) and young children (1-7 yr), compared with older children (8-17 yr), had a higher proportion of low-quality BMV breaths overall (86.0%, 85.5% vs. 57.9%; p < 0.001 for both), with inadequate or excessive VTe (57.7%, 61.1% vs. 43.7%; p < 0.001 for both), excessive leak (50.6%, 49.2% vs. 37.0%; p < 0.001 for both), and excessive PIP with excessive VTe (17.5%, 19.4% vs. 6.4%; p < 0.001). After controlling for respiratory pathology, low-quality BMV was associated with 2.8-times greater odds of adverse airway outcome (adjusted odds ratio, 2.8 [95% CI, 1.2-6.2]; p = 0.01).

CONCLUSIONS

The majority of BMV breaths delivered to children before tracheal intubation in the PICU were of low-quality. And, such breaths, were more frequent in younger children and were associated with greater odds of adverse airway outcomes.