Peak Pressures During Manual Ventilation

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INTRODUCTION: Manual (bag) ventilation sometimes achieves better oxygenation than does a mechanical ventilator. We speculated that clinicians might generate very high airway pressure during manual ventilation (much higher than the pressure delivered by a mechanical ventilator), and that the high airway pressure causes alveolar recruitment and thus improves oxygenation. Such high pressure might injure alveoli in some patients. METHODS: We tested the hypothesis that manual ventilation may involve substantially higher pressure than is delivered by a mechanical ventilator. We asked experienced respiratory therapists to manually ventilate a lung model that was set to represent several typical clinical scenarios. RESULTS: We found that the peak airway pressure generated by the therapists was sometimes in excess of 100 cm H2O. CONCLUSIONS: The high airway pressure during manual ventilation would be considered extreme in the context of conventional mechanical ventilation, which raises questions about whether manual ventilation causes barotrauma.


Document Type: Research Article

Affiliations: 1: Vermont Lung Center, Fletcher Allen Health Care, and University of Vermont, College of Medicine, Bington, Vermont 2: Vermont Lung Center, Fletcher Allen Health Care, and University of Vermont, College of Medicine, HSRF 228, 149 Beaumont Avenue, Bington VT 05405-0075;, Email:

Publication date: March 1, 2005

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