Pediatric self-inflating resuscitators

The dangers of improper setup

James O'Neill*, Charry Scott, Niranjan Kissoon, Peter Wludyka, Robert Wears, Robert Luten

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)


Self-inflating resuscitators (SIRs) are often used in pediatric resuscitation. Improper setup of the SIR can lead to inadequate ventilation and oxygenation. To present clinical scenarios in which SIRs delivered inadequate tidal volumes due to improper use. Second, to evaluate tidal volumes delivered using SIRs at varying lung compliances with the manometer and pop-off valve port open and closed. Third, to suggest methods to overcome improper use. Five pediatric resuscitators were tested under conditions simulating normal lungs, lungs with moderately decreased compliance, and lungs with poor compliance (0.015, 0.010, and 0.005 L/cm H 2O, respectively) to determine volumes delivered with proper SIR setup (manometer and pop-off valve closed) and improper SIR setup (manometer or pop-off valve open). With each SIR, an open manometer port or an open pop-off valve (improper setup) led to significant decreases in volume delivered. In normal lung compliance, the proper setup delivered 149 ± 10 cc, vs. 112 ± 12 cc, 106 ± 25 cc, and 90 ± 14 cc (pop-off open, manometer open, and both open, respectively). In poor lung compliance, the proper setup delivered 122 ± 13 cc, vs. 56 ± 10 cc, 70 ± 17 cc, and 44 ± 7 cc (pop-off open, manometer open, and both open, respectively). All differences above are significant (p < 0.0001). In a normal lung, the volumes delivered by SIRs are significantly decreased with the pop-off valve and manometer port open. Proper set-up of the SIR becomes even more important when lung compliance is poor.

Original languageEnglish
Pages (from-to)607-612
Number of pages6
JournalJournal of Emergency Medicine
Issue number6
Publication statusPublished - Dec 2011
Externally publishedYes


  • bag valve mask ventilator
  • emergency
  • malfunctions
  • manual ventilation
  • resuscitation
  • self-inflating resuscitator (SIR)

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    O'Neill, J., Scott, C., Kissoon, N., Wludyka, P., Wears, R., & Luten, R. (2011). Pediatric self-inflating resuscitators: The dangers of improper setup. Journal of Emergency Medicine, 41(6), 607-612.