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Pre-intubation ventilation device for bearded patients: prospective, randomized, crossover trial in anesthetized patients

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A Correction to this article was published on 22 February 2023

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Abstract

Having a beard is an independent predictor of difficult ventilation by face mask. This study evaluates the efficacy of a novel intra-oral Bag-Valve-Guedel Adaptor (BVGA) in anaesthetized bearded patients. Patients with ASA score 1–2, scheduled for elective surgery, were recruited for this prospective, crossover trial. Beard length was categorized as < 0.5 cm, 0.5–1 cm, 1–5 cm, or > 5 cm. Patients were ventilated by attending anesthesiologists using the BVGA and a facemask (both with a Guedel oral airway). End-tidal CO2 (EtCO2) and expiratory tidal volume (TV) were recorded as was the number of hands required for the procedure. The primary outcome was the difference between BVGA and Facemask. Sixty-one patients were enrolled. Of these, 38 had beards, and 23 were without beards or with beards < 0.5 cm length. In bearded patients, ventilation with the BVGA was superior to the face mask by EtCO2 and non-inferior by TV (BVGA-vs-Mask, mean [95% CI]: EtCO2 [mmHg], 33.0 [31.6, 34.3]-vs-27.2 [25.5, 28.8], p < 0.001; TV [ml∙kg−1 IBW], 8.1 [7.4, 8.9]-vs-6.9 [6.0, 7.7], p = 0.11). The BVGA was found to be superior to the face mask by EtCO2 across all beard lengths (p ≤ 0.001), but by TV only for the longest beard group (p = 0.009). After securing the BVGA, ventilation was possible without hands in 74% of the cases — clearly impossible with the facemask (p ≤ 0.001). The BVGA is more effective and more convenient than the facemask in anaesthetized bearded patients. A follow-up study is underway to test whether replacing the face mask with the BVGA will improve effectiveness and ease of pre-intubation field ventilation by less-experienced, first responders.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author, Dr. Lilach Gavish, upon reasonable request.

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Acknowledgements

SDG is the Brandman Foundation Professor of Cardiac and Pulmonary Diseases of The Faculty of Medicine, The Hebrew University of Jerusalem.

Funding

These studies were supported in part by The Stuart Roden Family Research Fund, London, UK; The Saul and Joyce Brandman Fund for Cardiovascular Research, The Alexander Grass Family Research Fund, The Dr. Bruce and Baila Waldholtz Research Fund, and The Dr. Martin and Grace Rosman Research Fund, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.

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Author notes

  1. Lilach Gavish and Shimon Firman contributed equally.

Authors and Affiliations

  1. Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel

    Lilach Gavish, Dina Velitsky, Arik Eisenkraft & S. David Gertz

  2. The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel

    Lilach Gavish & S. David Gertz

  3. Department of Anesthesiology, Critical Care and Pain Medicine, Hebrew University–Hadassah School of Medicine, Hadassah–Hebrew University Medical Center Jerusalem, Jerusalem, Israel

    Shimon Firman, Roger Andres Gomez Barrantes, Angelika Erport, Joel Shapiro, Chloe Mimouni & Reuven Pizov

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Correspondence to Lilach Gavish.

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Gavish, L., Firman, S., Barrantes, R.A.G. et al. Pre-intubation ventilation device for bearded patients: prospective, randomized, crossover trial in anesthetized patients. Intern Emerg Med 18, 559–566 (2023). https://doi.org/10.1007/s11739-023-03211-0

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