Page 11 - JSOM Fall 2024

Enhanced Manual Ventilation with a Handheld Audiovisual Device –

‘BENGI’ – Insights from a Pilot Study in Special Operations Medicine

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Luke A. White, MD, PhD **; Benjamin S. Maxey, MD **; Giovanni F. Solitro, PhD ;
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Steven A. Conrad, MD, PhD ; Karen P. Davidson, DHA, MSA, MEd, MSN, RN ;
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Ahmed Alhaque, MS ; J. Steven Alexander, PhD *
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ABSTRACT
Background: In emergency casualty and evacuation situations, or hyperventilation, which can increase intrathoracic pressure,
manual ventilation using self-inflating bags remains a critical impair hemodynamics, cause gastric insufflation and aspi-
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skill; however, significant challenges exist in ensuring safety ration, and directly induce forms of lung injury, especially
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and effectiveness, since inaccurate manual ventilation is asso- in cases of extreme hyperventilation. Consequently, groups
ciated with life-threatening risks (e.g., gastric insufflation with like the American Heart Association (AHA) and the European
aspiration, barotrauma, and reduced venous return). Methods: Resuscitation Council (ERC) strictly recommend avoiding hy-
This study assessed the impact of audiovisual feedback from perventilation during resuscitation for adult, pediatric, and
the bag-valve-mask (BVM) emergency narration guided instru- neonatal patients. 8–13 However, simulation and clinical studies
ment (BENGI), a handheld manual ventilation guidance device, have shown that even experienced healthcare personnel often
on improving performance and safety, immediately and 2 weeks manually hyperventilate patients, meaning that excessive V s
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after, with no additional manual ventilation training. In a cross- are delivered too often and/or breaths are administered at too
over manikin simulation study with 20 participants, BENGI high RRs. 3,4,14–18
immediately and significantly improved tidal volume and re-
spiratory rate accuracy. Results: Intra- and inter- participant To counter these risks, we developed the bag-valve-mask
variations were lower with BENGI, with Poincaré plot analysis (BVM) emergency narration guided instrument (BENGI), a
showing improved performance that remained for at least 2 handheld V feedback device that guides the user with simple
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weeks following BENGI training. Conclusion: BENGI’s audio- visual cues and concise voice commands on when to initiate
visual feedback improves manual immediately and persistently, bag compressions and when appropriate levels of manual ven-
making it invaluable for training and clinical use in diverse sce- tilation are reached. Although similar V monitoring devices
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narios, from battlespace to civilian emergencies. have been previously developed and tested, 20–23 the BENGI uses
simplified light cues and onboard narration guidance, which is
Keywords: ventilator; emergency; simulation; lung; tidal vol- unique. Additionally, none of the previous devices have been
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ume; monitoring tested for use in neonates, who are particularly susceptible to
hyperventilation. In this study, we evaluated the effective-
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ness of such audiovisual cues to improve manual ventilation
through improvements in V and RR accuracy and consistency
Introduction T
in adult, pediatric, and neonatal manual ventilation scenarios.
Manual ventilation is a common life-support procedure per-
formed by diverse healthcare personnel on patients, including Methods
military casualties, during the evacuation process. Although
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conceptually simple, manual ventilation requires correct se- Manual Ventilation Feedback Device
lection and placement of masks, head positioning, and most The BENGI (Supplementary Figure 1) is a handheld device that
critically, delivery of appropriate tidal volumes (V ) and respi- monitors inspiratory/expiratory airflow and delivered V s and
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ratory rates (RR). Incorrect manual ventilation can lead to ei- instructs users in real time using light-emitting diode indica-
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ther hypoventilation with insufficient pulmonary gas exchange tors and prerecorded voice commands. A spoken “Go” cue,
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*Correspondence to J. Steven Alexander, Molecular and Cellular Physiology, 1501 Kings Highway, Shreveport, LA 71103-3932 or jonathan.
alexander@lsuhs.edu
**The authors contributed equally to this work.
1 Luke A. White, Benjamin S. Maxey, Ahmed Alhaque, and J. Steven Alexander are affiliated with the Department of Molecular & Cellular
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Physiology at LSU Health Shreveport, Shreveport, LA, United States. Giovanni F. Solitro is affiliated with the Department of Orthopedic Surgery
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at LSU Health Shreveport, Shreveport, LA. Steven A. Conrad and J. Steven Alexander are affiliated with the Department of Medicine, Steven
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A. Conrad is affiliated with the departments of Emergency Medicine and Pediatrics. J. Steven Alexander and Ahmed Alhaque are affiliated with
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the Department of Neurology at LSU Health Shreveport, Shreveport, LA. Karen P. Davidson is affiliated with the School of Health Sciences and
School of Public Health at Liberty University, Lynchburg, VA, the United States, School of Health Sciences at Central Michigan University, Mt.
Pleasant, MI, and the United States Air Force Reserves Nurse Corp, Aeromedical Evacuation.
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