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Using flow-rate limiting bag-valve-mask device without training


The Smart Bag (SB, O-Two Medical Technologies Inc., Canada) is a bag-valve-mask resuscitator (BVM) equipped with a valve limiting flow-rate and peak airway pressure to decrease hyperventilation and gastric insufflation. We studied this device used by hospital staff without training to evaluate the possibility to change the standard BVM to the SB in hospital wards where positive pressure ventilation is rarely needed and training is sporadic.


The participants (12 physicians, 38 nurses) were randomised to use the standard BVM or SB to ventilate a resuscitation training manikin over 1 minute. The mechanism of the SB was shortly described in the SB group but no hands-on training was provided. Participants were asked to ventilate the patients as they would do if patients have a pulse but do not breathe. Tidal volumes were registered to a computer connected to the manikin.


The medians of minute ventilation were 6.1 (interquartile range 2.6 to 8.1) and 3.9 (IQR 1.7 to 5.4) litres per minute in the SB and control groups, respectively (Figure 1). Hyperventilation >10 l/minute occurred only in the control group (P = 0.23).

Figure 1

Minute ventilation (ml) in the Smart Bag group and the control group.


Using the SB without previous hands-on training is possible for the majority of nursing and medical staff and decreases hyperventilation in comparison with the standard BVM.

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Correspondence to J Nurmi or M Castrén.

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Nurmi, J., Castrén, M. Using flow-rate limiting bag-valve-mask device without training. Crit Care 14, P305 (2010).

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  • Public Health
  • Emergency Medicine
  • Interquartile Range
  • Tidal Volume
  • Airway Pressure