Bag-mask ventilation is often used as a way to supplement or
replace spontaneous patient respiratory attempts prior to endotracheal
intubation. Various anatomic issues (ie, excess soft tissue, large
tongue) may necessitate the insertion of an artificial airway to
permit bag-mask ventilation.
- ▪ Resuscitation bag: Typically a self-reinflating bag
with standard connectors for oxygen administration and connection
to a face mask and/or endotracheal tube connector (Figure
- —Valved to separate inhaled gas from exhaled
- —Permits ventilation with room air in the absence
of a supplemental oxygen supply
- —Permits ventilation with oxygen enriched gas when
connected to an oxygen supply
- ▪ Face mask: A soft cuff mask designed to fit over the
nose and mouth of a patient with a seal permitting positive pressure
ventilation without gas leak (Figure 24-2)
- —Various sized masks permit selection of the
appropriate size for a given patient.
- —Masks are equipped with a universal connector for
attachment to resuscitation bag and/or ventilator tubing.
- —Transparent plastic masks permit recognition of
vomitus if the patient regurgitates.
Figure 24-1. Figure 24-2.
Resuscitation bag, mask, and tubing.
Face mask with attached PEEP valve.
- ▪ Select appropriate mask for patient’s face
- ▪ Apply mask to face over nose and mouth with left hand.
- ▪ The thumb should be above the endotracheal tube connector
and the index finger below, with the remaining fingers spread along
mandible (Figure 24-3).
- ▪ The bag should be compressed in coordination with the patient’s
inspiratory effort, if present or at a rate between 10 and 20 breaths/min
if patient efforts absent.
- ▪ The chest should be inspected for appropriate rise and
fall with bag compressions.
- ▪ The abdomen should be inspected for enlargement to determine
whether the stomach is being inflated with bag compressions.
Clinical Pearls and Pitfalls
- ▪ Patients
with certain kinds of facial anatomy (ie, beard, edentulous, excess
soft tissue) are difficult to ventilate with a mask.
- ▪ The mask
can be rocked in various directions to enhance the seal.
- ▪ If it becomes
apparent that the stomach is inflating, an artificial airway should
be placed, and Sellick’s maneuver performed (see Chapter 27) to compress esophagus during ventilation—the stomach
should then be decompressed following endotracheal intubation if