Introduction

Respiration is basic requisite for survival of living beings. Unfortunately, when this drive to breathe is dysregulated by a variety of health conditions, one’s biological equilibrium transposes to the state of respiratory failure. In such conditions, mechanical or assisted ventilation is cornerstone of management and proves lifesaving.1 2 As the name says, mechanical ventilation is medical terminology used for artificial ventilation where external devices are connected directly to the patient as measures to support breathing.

These manual mechanical resuscitators are in use since late 1950s3 and provide excellent means of short-term ventilation in both out-of-hospital and in-hospital environments. In many low-income countries, critical care still lies in infancy,4 where basic healthcare technology is minimal and high cost is a major impediment to the availability of ventilators in hospitals. Also, most of the information pertaining to respiratory failure burden is from high-income countries. There are no reliable epidemiological data available and there is substantial disparity in quality of care within low-income countries.5 Therefore, this potentially high burden of patients and mortality with respiratory failure can be minimised if provision of mechanical ventilators is implemented in a thoughtful fashion. Getting a ventilator on the arrival of a patient in emergency or trauma centres is a real challenge. This leads to a situation where many salvageable patients are unable to get the best care and succumb to their illness.6

To tide over this crisis, presently, a large number of patients are being ventilated with the help of a mechanical device manually (figure 1): an artificial manual breathing unit (AMBU), which is a simple hand-held self-inflatable device that needs to be compressed manually by patients’ attendant/caretaker on a regular basis to deliver air or oxygen to patients’ lungs. Providing continuous manual …