Manuscript submission to military medicine

Abstract to Manuscript Feasibility of Prolonged Manual Ventilation Abstract IntroductionProlonged field care may require manual ventilation to be performed for long periods of time, but the feasibility of prolonged ventilation is not well described. This study examined the viability of prolonged manual ventilation by assessing the performance of participants squeezing a manual resuscitation bag for 8 hours, with and without an FDA-approved flow-limiting valve.Materials and Methods90 adult subjects with and without BLS certifications performed manual ventilation for up to 8 hours. A standard adult resuscitator bag with a disposable air flow sensor recording flow. Peak pressures were measured by an integrated digital pressure sensor Analog Microelectronics. Half the participants were randomized to using a flow-limiting device (Sotair, SafeBVM) which was attached to the bag. Half the participants were also randomized to a low-compliance condition lung, and the other half to a normal compliance lung. Subjects were instructed to target 500mL tidal volume and 12 breaths per minute. To assess the impact of a timing device, a metronome set to 12 beats/minute was provided for the second four hours of ventilation. Participants filled out fatigue scales at the end of each hour.ResultsNone of the 90 participants stopped the study because of fatigue or injury. With and without Sotair there was a significant trend towards more fatigue over time on both the Modified Borg Scale Rate of Perceived Exertion and the Samn-Perelli Fatigue Checklist There was no significant difference in either fatigue scale between the group who used Sotair and the group that did not. A multivariate regression analysis of minute ventilation demonstrated significant effects with respect to time, presence of a metronome, and use of Sotair; compliance and having BLS certification were not statistically significant.ConclusionsTo our knowledge this represents the largest quantitative data set examining prolonged ventilation. This study suggests that prolonged manual ventilation is viable, and that even minimally trained personnel can provide manual ventilation for prolonged periods of time. Increasing fatigue over 8 hours of ventilation was expected; no participants had to stop because of fatigue. Target: Military Medicine Format: ~3,000 words; up to 4 tables/figures; up to 40 references Target submission: end of Sept 2026 - Review the supplied abstract, slide deck, background papers, analysis outputs, and proposed figures/tables. - Develop a complete manuscript draft around the agreed storyline, including: - Integrate consolidated author feedback through agreed revision rounds. - Prepare the final submission-ready manuscript package, including any supplemental material formatting as needed. The paper will focus on: - Feasibility of prolonged manual ventilation. - Performance by non-medically trained personnel with rapid SotairIQ and Sotair training - Improved ventilation consistency with metronome use. - Safety outcomes, including over- and under-ventilation, with peak inspiratory pressure trends reviewed. - Military application and relevance to TCCC guidelines for small bag - Fatigue and physiologic outcomes, including fatigue scales, grip data, heart rate, and SpO₂. More information needed: - Fixed fee and what it covers. - Number of draft/revision rounds included. - Turnaround time for a first full draft after receiving complete materials. - Cost and scope for reformatting/resubmission if Military Medicine does not accept the manuscript. - How AI is used, if at all, in drafting, editing, figures, references, or other workflow steps, given journal disclosure requirements.