{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:45:34Z","timestamp":1789440334749,"version":"build-2803163510"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"7-8","license":[{"start":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T00:00:00Z","timestamp":1709337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100014047","name":"711th Human Performance Wing","doi-asserted-by":"publisher","award":["FA8650-15-2-6D22"],"award-info":[{"award-number":["FA8650-15-2-6D22"]}],"id":[{"id":"10.13039\/100014047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014047","name":"711th Human Performance Wing","doi-asserted-by":"publisher","award":["FA8650-15-2-6D22"],"award-info":[{"award-number":["FA8650-15-2-6D22"]}],"id":[{"id":"10.13039\/100014047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Traumatic brain injury (TBI) is the leading cause of combat casualties in modern war with an estimated 20% of casualties experiencing head injury. Since the release of the Brain Trauma Foundation\u2019s Guidelines for the Management of Severe Traumatic Brain Injury in 1995, recommendations for management of TBI have included the avoidance of routine hyperventilation. However, both published and anecdotal data suggest that many patients with TBI are inappropriately ventilated during transport, thereby increasing the risk of morbidity and mortality from secondary brain injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Enlisted Air Force personnel with prior emergency medical technician training completing a 3-week trauma course were evaluated on their ability to provide manual ventilation. Participants provided manual ventilation using either an in-situ endotracheal tube (ETT) or standard face mask on a standardized simulated patient manikin with TBI on the first and last days of the course. Manual ventilation was provided via a standard manual ventilator and a novel manual ventilator designed to limit tidal volume (VT) and respiratory rate (RR). Participants were given didactic and hands-on training on the third day of the course. Half of the participants were given simulator feedback during the hands-on training. All students provided 2\u2009minutes of manual ventilation with each respirator. Data were collected on the breath-to-breath RR, VT, and peak airway pressures generated by the participant for each trial and were averaged for each trial. A minute ventilation (MV) was then derived from the calculated RR and VT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>One hundred fifty-six personnel in the trauma course were evaluated in this study. Significant differences were found in the participant\u2019s performance with manual ventilation with the novel compared to the traditional ventilator. Before training, MV with the novel ventilator was less than with the traditional ventilator by 2.1\u2009\u00b1\u20090.4\u2009L\/min (P\u2009=\u2009.0003) and 1.6\u2009\u00b1\u20090.5\u2009L\/min (P\u2009=\u2009.0489) via ETT and face mask, respectively. This effect persisted after training with a difference between the devices of 1.8\u2009\u00b1\u20090.4\u2009L\/min (P\u2009=\u2009.0069) via ETT. Both traditional education interventions (didactics with hands-on training) and simulator-based feedback did not make a significant difference in participant\u2019s performance in delivering MV.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The use of a novel ventilator that limits RR and VT may be useful in preventing hyperventilation in TBI patients. Didactic education and simulator-based feedback training may not have significant impact on improving ventilation practices in prehospital providers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae030","type":"journal-article","created":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T18:04:22Z","timestamp":1709402662000},"page":"e1393-e1396","source":"Crossref","is-referenced-by-count":1,"title":["Hyperventilation During Manual Ventilation Can Be Reduced Using a Novel Ventilator but Not With Education Interventions"],"prefix":"10.1093","volume":"189","author":[{"given":"Andrea R","family":"Trent","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3887-0143","authenticated-orcid":false,"given":"Raymond","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Bayview Medical Center , Baltimore, MD 21224,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hegang","family":"Chen","sequence":"additional","affiliation":[{"name":"Epidemiology & Public Health; Anesthesiology, University of Maryland School of Medicine , Baltimore, MD 21201,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis C","family":"Copeland","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, U.S. Air Force Center for Sustainment of Trauma Readiness Skills , Baltimore, MD 21201,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2946-4074","authenticated-orcid":false,"given":"Napoleon P","family":"Roux","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, San Antonio Military Medical Center , Fort Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E","family":"Grissom","sequence":"additional","affiliation":[{"name":"Epidemiology & Public Health; Anesthesiology, University of Maryland School of Medicine , Baltimore, MD 21201,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,2]]},"reference":[{"issue":"2","key":"2025030423011295500_R1","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1097\/ACO.0b013e32834458da","article-title":"Traumatic brain injury in modern warfare","volume":"24","author":"Ling","year":"2011","journal-title":"Curr Opin Anesthiol"},{"key":"2025030423011295500_R2","first-page":"1","volume-title":"Anesthesia and Perioperative Care of the Combat Casualty","author":"Bellamy","year":"1995"},{"key":"2025030423011295500_R3","volume-title":"Guidelines for the Management of Severe Traumatic Brain Injury","author":"Bratton","year":"2007","edition":"3rd"},{"issue":"1","key":"2025030423011295500_R4","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/00005373-200201000-00010","article-title":"Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice","volume":"52","author":"Thomas","year":"2002","journal-title":"J Trauma"},{"issue":"4","key":"2025030423011295500_R5","doi-asserted-by":"publisher","first-page":"S181","DOI":"10.1097\/TA.0000000000000769","article-title":"Early in-theater management of combat-related traumatic brain injury: a prospective, observational study to identify opportunities for performance improvement","volume":"79","author":"Fang","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"2025030423011295500_R6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s13054-018-1994-0","article-title":"Respiratory management in patients with severe brain injury","volume":"22","author":"Asehnoune","year":"2018","journal-title":"Crit Care"},{"key":"2025030423011295500_R7","article-title":"Best practices in the management of traumatic brain injury","volume-title":"American College of Surgeons, Trauma Quality Improvement Program","author":"Committee on Trauma","year":"2015"},{"issue":"3","key":"2025030423011295500_R8","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1093\/bja\/aeg069","article-title":"Tight control of prehospital ventilation by capnography in major trauma victims","volume":"9","author":"Helm","year":"2003","journal-title":"Br J Anaesth"},{"issue":"2","key":"2025030423011295500_R9","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1017\/S1049023X12001768","article-title":"Utility of prehospital quantitative end tidal CO2?","volume":"28","author":"Cooper","year":"2013","journal-title":"Prehosp Disaster Med"},{"issue":"6","key":"2025030423011295500_R10","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1016\/j.resuscitation.2011.01.029","article-title":"Novel target volume marked adult bag to deliver accurate tidal volume for pediatric and adolescent resuscitation","volume":"82","author":"Park","year":"2011","journal-title":"Resuscitation"},{"issue":"10","key":"2025030423011295500_R11","doi-asserted-by":"publisher","first-page":"1422","DOI":"10.1016\/j.resuscitation.2013.04.005","article-title":"A one-day \u201cHelping Babies Breathe\u201d course improves simulated performance but not clinical management of neonates","volume":"84","author":"Ersdal","year":"2013","journal-title":"Resuscitation"},{"issue":"5","key":"2025030423011295500_R12","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1016\/j.jemermed.2012.11.005","article-title":"Face mask ventilation: a comparison of three techniques","volume":"44","author":"Hart","year":"2013","journal-title":"J Emerg Med"},{"issue":"1","key":"2025030423011295500_R13","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.annemergmed.2013.07.014","article-title":"Comparison of bag-valve-mask hand-sealing techniques in a simulated model","volume":"61","author":"Otten","year":"2014","journal-title":"Ann Emerg Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/7-8\/e1393\/58435626\/usae030.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/7-8\/e1393\/58435626\/usae030.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T23:01:20Z","timestamp":1741129280000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/7-8\/e1393\/7617860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,2]]},"references-count":13,"journal-issue":{"issue":"7-8","published-online":{"date-parts":[[2024,3,2]]},"published-print":{"date-parts":[[2024,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae030","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,7]]},"published":{"date-parts":[[2024,3,2]]}}}