Oxygen enrichment of bag-valve-mask units during positive-pressure ventilation: A comparison of various techniques

doi:10.1016/S0196-0644(88)80113-6

Annals of Emergency Medicine

Volume 17, Issue 3, March 1988, Pages 232-235

https://doi.org/10.1016/S0196-0644(88)80113-6 Get rights and content

Bag-mask devices are used frequently to provide patients with positive-pressure-assisted ventilation. To increase the percentage of oxygen delivered (F_DO₂) from the bag, supplemental oxygen must be provided by way of an oxygen inlet nipple attached to the unit. Using ten medical volunteers and a test lung with oxygen analyzer, we studied the effect of several variables on the F_DO₂ and determined the most effective reservoir that would provide the highest consistent F_DO₂ from the ventilating port of the bag. An F_DO₂ of 1.00 was consistently provided by the 2.5-L bag reservoir and a demand-valve set-up attached to the reservoir port of the ventilating bag. Bag refill time significantly affected the F_DO₂ when no reservoir or corrugated tube reservoirs were used. Corrugated tube reservoirs were found to be more sensitive to all variations in ventilatory technique and to oxygen flow rates. From our findings were recommend that corrugated tube reservoirs not be used for oxygen supplementation, as they are sensitive to variations in ventilatory technique and cannot alert clinicians to problems with oxygen flow. While both the 2.5-L bag reservoir and demand-valve provide a consistent F_DO₂ of 1.00, the demand valve has the advantage of audible filling of the ventilating bag as well as being compact and independent of ventilatory technique.

References (10)

HarrisonRR et al.
Mouth-to-mask ventilation: A superior method of rescue breathing
Ann Emerg Med
(1982)
EllingR et al.
An evaluation of emergency medical technicians' ability to use manual ventilation devices
Ann Emerg Med
(1983)
JesudianMCS et al.
Bag-valve-mask ventilation, two rescuers are better than one: A preliminary report
Crit Care Med
(1985)
American Heart Association Committee on Emergency Cardiac Care
Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC)
JAMA
(1986)
SafarP
Cardiopulonary Cerebral Resuscitation

There are more references available in the full text version of this article.

Cited by (20)

Optimal Airway Management in Cardiac Arrest
2020, Critical Care Clinics
Citation Excerpt :
Finally, a positive end-expiratory pressure (PEEP) valve may be attached to the reservoir port of the bag to help maintain PEEP and to allow for better oxygenation and ventilation while performing BVM ventilations. Adequate oxygenation and ventilation with a BVM require a good face mask seal, which may be difficult in patients with facial trauma, facial hair, or anatomic anomalies or in those who are edentulous.7 SGAs, including the King LT (Ambu, Copenhagen, Denmark) and i-gel (Intersurgical, Wokingham, Berkshire, United Kingdom), have been suggested as primary airway management strategy in cardiac arrest because they can successfully be placed rapidly and potentially reduce interrupts in chest compressions.8,9
Airway Management in the Critically Ill Adult
2008, Critical Care Medicine: Principles of Diagnosis and Management in the Adult
Airway management
2004, Surgical Decision Making
Concepts and application of prehospital ventilation
2001, Prehospital Emergency Care
Airway management and optimal ventilation are crucial aspects of managing out-of-hospital medical emergencies. The goals in these situations are controlled ventilation and optimized inspiratory time, expiratory time, and airflow. Numerous techniques and devices are available to deliver oxygen-enriched air to patients during resuscitation. The bag-valve-mask (BVM) is one of the most common devices used to provide ventilation, although the American Heart Association ranks BVM devices lower in preference than other ventilation adjuncts, such as emergency and transport ventilators (ETVs) and pocket masks. The clearly documented limitations of BVM ventilation and its widespread use in the United States underscore the need to improve ventilation practices during care provided by emergency medical services (EMS) personnel. As part of that improvement, ETVs clearly have a role in the prehospital setting. These devices should be available on every ambulance, and the ability to use ETVs should be part of each EMS provider's skill set. Furthermore, all patients requiring emergency ventilation must be adequately monitored, including continuous monitoring of end-tidal carbon dioxide concentrations. As with any other skill, ventilation requires attention during initial training, continuing education and skill reinforcement, and quality review. PREHOSPITAL EMERGENCY CARE 2001;5:73-78
A Comparison of Expiratory Flow Rates in Two Breathing Circuits Used for Manual Inflation of the Lungs
1991, Physiotherapy (United Kingdom)
Manual inflation of the lungs by the ‘bag squeezing method’ (bagging) is commonly used by physiotherapists in the management of intubated patients. A wide variety of ‘bagging’ circuits are available and the peak expiratory flow rate that can be achieved is influenced by the circuit components. A high expiratory flow rate is desirable as it is believed to be one of the factors that determines the effectiveness of secretion mobilisation during a simulated cough in intubated patients.
This study was designed to compare the expiratory flow rates resulting from the elastic recoil of a test-lung using the Mapleson-C breathing system and the Laerdal self-inflating resuscitator. Our data demonstrated that for any given pressure gradient the measured peak expiratory flow was higher with the Laerdal self-inflating resuscitator (p < 0.001). Further studies are required to assess the influence of circuit-type pulmonary secretion mobilisation in clinical practice.
Cardiopulmonary resuscitation
2016, Surgical Intensive Care Medicine, Third Edition

View all citing articles on Scopus

: Presented at the University Association for Emergency Medicine Annual Meeting in Portland, Oregon, May 1986.

View full text

Original contributionOxygen enrichment of bag-valve-mask units during positive-pressure ventilation: A comparison of various techniques

Ann Emerg Med

Ann Emerg Med

Bag-valve-mask ventilation, two rescuers are better than one: A preliminary report

Crit Care Med

Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC)

JAMA

Cardiopulonary Cerebral Resuscitation

Original contribution
Oxygen enrichment of bag-valve-mask units during positive-pressure ventilation: A comparison of various techniques