Impact of duration of Prolong Manual Bag ventilated patients in the Emergency Service

Abstract

Introduction: There are increasing numbers of critically ill patients who need urgent emergency intubation in Emergency Service. Due to limited number of ventilators and even lack of portable ventilators in emergency room, we need to continue prolong manual bag ventilation of those patients after emergency intubation. Therefore, the aim was to analyse the impact of duration of prolong manual bag ventilated patients in the Emergency Service, Tribhuvan University Teaching Hospital in Nepal.

Methods: This was a prospective non-interventional cross-sectional study conducted from August 2012 to July 2013 (one year). This study included those Emergency Intubation cases with written informed consent from patient's party/guardian/legal representative to enroll in this study and excluding otherwise.

Results: 172 (0.4% of 45000 emergency room patients) patients were enrolled and divided in to Group I: Manual Bag Ventilation without Mechanical Ventilation (MBV-MV)-56 (32.6%) and Group II. MBV with MV (MBV+MV) 116 (67.4%) with accounting the incidence of such critically ill rarely found cases. The age ranges from 11 to 94 years with mean 49+-19. There were 33 Alive and 139 Death (p 0.006), M:F=1.32:1, MBV duration was with median 540 min (p0.02), 22.7% had <180 minutes MBV with survival rate 28.25% (OR 1.98, p 0.162 comparing with >181 minutes), 58.2% cases were only MBV in ER with 100% mortality. 41.2% had mechanical ventilation after MBV with median 3 days, mean 5.0+-SD 4.9 days in ICUs with 71.5% crude ill-defined mortality (p 0.042, ROC0.704). The probability of survival after emergency intubation varies with duration of MIBV as 0.8 in 1hr (7.1% mortality) and 0.02 after 24hrs (92.3% mortality) with underlying causes and availability of present treatment.

Conclusion: Irrespective of underlying causes, due to prolong manual bag ventilation without mechanical ventilation; there was increase chance of mortality and even 100% mortality as ill-defined crude mortality.