{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:21:35Z","timestamp":1783581695438,"version":"3.55.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>This study evaluated the performance of Airgency\u2122, an automated bag valve mask (BVM) ventilation device developed by Institut Teknologi Bandung and Padjadjaran University, Indonesia, using a manikin-based simulation model. Its performance was compared with conventional hand-squeezed bagvalvemask ventilation performed by medical professionals, with a focus on reducing operator-dependent variability and fatigue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A manikin-based simulation was conducted using an adult airway trainer connected to a lung simulator (ASL5000) set to mimic apneic respiratory failure with normal lung mechanics. The Ambu bag, connected to 15 L\/min oxygen, was secured to the manikin. Airgency\u2122 operated in normal mode (tidal volume [VT] 400 mL, 15 bpm) for 30 min, repeated 50 times. Seventy-eight anesthesiology residents performed manual BVM ventilation under identical conditions after standardized training. Breathing rate (BR), VT, and peak inspiratory pressure (PIP) were recorded every minute, whereas fatigue was rated using the Visual Analog Scale for Fatigue (VAS-F, 1\u201310).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Airgency\u2122 demonstrated superior ventilation stability. BR remained consistent (14.77 \u00b1 0.08 vs. 16.54 \u00b1 7.05 bpm;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001), with much lower variability (coefficient of variation [CV] 0.47% vs. 46.1%\u2013121.2%). VT delivery was steady (397.8 \u00b1 3.1 vs. 406.9 \u00b1 85.4 mL;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001; CV 2.2% vs. 13.9%\u201325.7%), and PIP was more uniform (29.4 \u00b1 0.9 vs. 23.1 \u00b1 8.2 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.00001; CV 2.5% vs. 28.3%\u201341.1%). Operator fatigue increased progressively during manual ventilation (VAS-F 1.83\u20135.09;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Airgency\u2122 maintained consistent, precise ventilation with minimal variability and eliminated operator fatigue, supporting its potential as a reliable alternative to manual BVM ventilation in emergency care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/tjem.tjem_146_25","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:01:50Z","timestamp":1783580510000},"page":"205-216","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Manikin-based noninferiority simulation study of Airgency\u2122: A novel automatic bag valve mask device for emergency respiratory support"],"prefix":"10.4103","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5966-4846","authenticated-orcid":false,"given":"Reza Widianto","family":"Sudjud","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Padjadjaran University\/Dr. Hasan Sadikin General Central Hospital, Bandung, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1907-9885","authenticated-orcid":false,"given":"Jenifer Kiem","family":"Aviani","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Padjadjaran University\/Dr. Hasan Sadikin General Central Hospital, Bandung, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"R1-20260709","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/CNQ.0000000000000102","article-title":"Pathophysiology and classification of respiratory failure","volume":"39","author":"Lamba","year":"2016","journal-title":"Crit Care Nurs Q"},{"key":"R2-20260709","doi-asserted-by":"crossref","first-page":"751","DOI":"10.4187\/respcare.00841","article-title":"Bench tests of simple, handy ventilators for pandemics: Performance, autonomy, and ergonomy","volume":"56","author":"L'Her","year":"2011","journal-title":"Respir Care"},{"key":"R3-20260709","doi-asserted-by":"crossref","first-page":"366","DOI":"10.4187\/respcare.08296","article-title":"Agas-powered, patient-responsive automatic resuscitator for use in acute respiratory failure: A bench and experimental study","volume":"66","author":"Jonkman","year":"2021","journal-title":"Respir Care"},{"key":"R4-20260709","doi-asserted-by":"crossref","first-page":"100350","DOI":"10.1016\/j.resplu.2022.100350","article-title":"Improved simulated ventilation with a novel tidal volume and peak inspiratory pressure controlling bag valve mask: A pilot study","volume":"13","author":"Merrell","year":"2023","journal-title":"Resusc Plus"},{"key":"R5-20260709","first-page":"250","article-title":"Sample size calculations for comparing groups with continuous outcomes","volume":"29","author":"Zheng","year":"2017","journal-title":"Shanghai Arch Psychiatry"},{"key":"R6-20260709","doi-asserted-by":"crossref","first-page":"722","DOI":"10.5811\/westjem.2020.3.45788","article-title":"It's in the bag: Tidal volumes in adult and pediatric bag valve masks","volume":"21","author":"Dafilou","year":"2020","journal-title":"West J Emerg Med"},{"key":"R7-20260709","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.resuscitation.2011.09.010","article-title":"Comparison of manually triggered ventilation and bag-valve-mask ventilation during cardiopulmonary resuscitation in a manikin model","volume":"83","author":"Bergrath","year":"2012","journal-title":"Resuscitation"},{"key":"R8-20260709","doi-asserted-by":"crossref","first-page":"igz036","DOI":"10.1093\/geroni\/igz036","article-title":"Effect size guidelines, sample size calculations, and statistical power in gerontology","volume":"3","author":"Brydges","year":"2019","journal-title":"Innov Aging"},{"key":"R9-20260709","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1378\/chest.14-3169","article-title":"Pressure-controlled versus volume-controlled ventilation in acute respiratory failure: A physiology-based narrative and systematic review","volume":"148","author":"Rittayamai","year":"2015","journal-title":"Chest"},{"key":"R10-20260709","doi-asserted-by":"crossref","first-page":"R6","DOI":"10.1186\/cc7695","article-title":"Automatic versus manual pressure support reduction in the weaning of post-operative patients: A randomised controlled trial","volume":"13","author":"Taniguchi","year":"2009","journal-title":"Crit Care"},{"key":"R11-20260709","first-page":"4521767","article-title":"Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations?","author":"Khoury","year":"2016","journal-title":"Biomed Res Int 2016"},{"key":"R12-20260709","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1097\/CCM.0000000000001189","article-title":"Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome: A systematic review and individual patient data analysis","volume":"43","author":"Neto","year":"2015","journal-title":"Crit Care Med"},{"key":"R13-20260709","first-page":"CD011151","article-title":"Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in adults without acute lung injury","volume":"7","author":"Guay","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"R14-20260709","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.aucc.2010.03.003","article-title":"Clinical application of ventilator modes: Ventilatory strategies for lung protection","volume":"23","author":"Rose","year":"2010","journal-title":"Aust Crit Care"},{"key":"R15-20260709","doi-asserted-by":"crossref","first-page":"583","DOI":"10.3390\/pathophysiology31040042","article-title":"Pathophysiology and prevention of manual-ventilation-induced lung injury (MVILI)","volume":"31","author":"White","year":"2024","journal-title":"Pathophysiology"},{"key":"R16-20260709","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1111\/anae.13099","article-title":"Reliability of manikin-based studies: An evaluation of manikin characteristics and their impact on measurements of ventilatory variables","volume":"70","author":"De Luca","year":"2015","journal-title":"Anaesthesia"},{"key":"R17-20260709","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.ajem.2020.09.091","article-title":"An evaluation of manual tidal volume and respiratory rate delivery during simulated resuscitation","volume":"45","author":"Scott","year":"2021","journal-title":"Am J Emerg Med"},{"key":"R18-20260709","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1097\/01.ccm.0000552239.10568.c1","article-title":"1496: Tidal volume and respiratory rate assessment during manual ventilation","volume":"47","author":"Li","year":"2018","journal-title":"Crit Care Med"},{"key":"R19-20260709","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.hrtlng.2020.10.012","article-title":"Manual bag valve mask ventilation performance among respiratory therapists","volume":"50","author":"Culbreth","year":"2021","journal-title":"Heart Lung"},{"key":"R20-20260709","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s13049-019-0674-7","article-title":"Ventilation feedback device for manual ventilation in simulated respiratory arrest: A crossover manikin study","volume":"27","author":"Khoury","year":"2019","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"R21-20260709","doi-asserted-by":"crossref","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"},{"key":"R22-20260709","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.resuscitation.2010.05.005","article-title":"An evaluation of bag-valve-mask ventilation using an ergonomically designed facemask among novice users: A simulation-based pilot study","volume":"81","author":"Bauman","year":"2010","journal-title":"Resuscitation"},{"key":"R23-20260709","first-page":"892","article-title":"Comparison of muscle exertion and fatigue between standard bag valve mask and NuMask","volume":"56","author":"Riggle","year":"2012","journal-title":"Proc Hum Fact Ergo Soc Ann Meet"},{"key":"R24-20260709","doi-asserted-by":"crossref","first-page":"e222","DOI":"10.1097\/CCM.0000000000003632","article-title":"Six hours of manual ventilation with a bag-valve-mask device is feasible and clinically consistent","volume":"47","author":"Halpern","year":"2019","journal-title":"Crit Care Med"},{"key":"R25-20260709","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/0972-5229.25926","article-title":"Guidelines for noninvasive ventilation in acute respiratory failure","volume":"10","author":"Chawla","year":"2006","journal-title":"Indian J Crit Care Med"},{"key":"R26-20260709","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1136\/medethics-2019-105992","article-title":"Parental manual ventilation in resource-limited settings: An ethical controversy","volume":"46","author":"Barsky","year":"2020","journal-title":"J Med Ethics"}],"container-title":["Turkish Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.4103\/tjem.tjem_146_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:01:53Z","timestamp":1783580513000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.4103\/tjem.tjem_146_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/tjem.tjem_146_25","relation":{},"ISSN":["2452-2473","2452-2473"],"issn-type":[{"value":"2452-2473","type":"print"},{"value":"2452-2473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-04-28","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}