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Feasibility of manual ventilation replacing mechanical ventilation
  1. Mark F Brady1,
  2. Nicole K Weber2,
  3. Richard Walker, III1,
  4. Joseph E Holley1,
  5. Samantha A Ni1,
  6. Shane Young1,
  7. Ethan D Monhollon1,
  8. Randy S Carpenter3,
  9. Jack W Tsao2
  1. 1Department of Emergency Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
  3. 3The University of Tennessee Health Science Center, Memphis, Tennessee, USA
  1. Correspondence to Dr Mark F Brady, Emergency Medicine, Methodist University Hospital, Memphis, TN 38104, USA; brady{at}


Background During the COVID-19 pandemic it is anticipated that there will be a shortage of mechanical ventilators available for patients in critical condition. This has sparked many discussions about rationing resources and withholding care; however, an alternative may be to implement manual ventilation in these situations instead. Manual ventilation and a safety device were assessed for efficacy of extended use, such as may be required during this pandemic.

Methods To evaluate physical output characteristics of extended manual ventilation and efficacy of a barotrauma mitigation device, 47 medical students, nurses and medics completed two 1-hour manual ventilation sessions using the SmartLung 2000 Lung Simulator and 5300 Series Mass Flow Meter with a SPUR II resuscitator bag and endotracheal tube, mimicking a healthy adult with normal lung physiology, both with and without the Sotair device. Providers were randomised to complete their initial session either with or without the Sotair device.

Findings Collected data show wide variability in tidal volume and peak pressure in unmitigated manual breaths despite prior training and independent exploration of the resuscitation equipment prior to testing. The mean (±SD) tidal volume with bag only was 563.9±128.8 mL and with the safety device 536.1±80.9 mL (p<0.0001). The mean peak inspiratory pressure with bag only was 17.2±6.3 cm H2O and with the safety device 14.9±2.4 cm H2O (p<0.0001).

Interpretation While extended manual ventilation cannot replace mechanical ventilation, it is feasible with a safety device, which may reduce barotrauma, underventilation and overventilation. These results also demonstrate that withholding care and rationing resources may not be necessary.

  • critical care
  • emergency medicine
  • biomedical engineering
  • pulmonary medicine
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  • Contributors MFB conceived the project and study design, managed data collection, assisted with statistical analysis and assisted with manuscript preparation. NKW assisted with manuscript preparation. RW assisted with study design and manuscript preparation. JEH assisted with study design and manuscript preparation. SAN assisted with study design and data collection. SY assisted with study design and data collection. EDM assisted with data collection and manuscript preparation. RSC assisted with study design and data collection. JWT assisted with data review and manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This protocol was approved by the University of Tennessee Health Science Center Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article. Deidentified participant data are available upon request. Please contact Dr Mark Brady for permissions for reuse.

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