Background

Bag–mask (BM) ventilation is the most important skill in paediatric airway management. This non-invasive manoeuvre for assisted, positive-pressure ventilation is effective treatment for most children with hypoventilation and hypoxia. A child with respiratory insufficiency may require only temporary assisted ventilation with BM. Some children in respiratory failure who require prolonged ventilation or airway protection may need tracheal intubation (Chapter 23.3).

In the BM setup, oxygen flows into a bag reservoir, through a pop-off valve, and into a mask, which forms a tight seal around the child’s nose and mouth. Squeezing the bag administers oxygen under positive pressure to the lungs. While this manoeuvre does not fully protect the airway, as tracheal intubation does, BM ventilation adequately provides emergent airway support during the acute decompensation period (Table 23.2.1). Additionally, Gausche et al demonstrated that BM ventilation is as effective as tracheal intubation in the pre-hospital setting for airway management, regardless of the underlying aetiology.¹ Thus, both pre-hospital and in-hospital practitioners must be comfortable and proficient in performing BM ventilation.

Table 23.2.1 Choosing BM ventilation versus tracheal intubation

Sample patient case BM Intubation Hypoventilation during procedural sedation +   Hypoventilation during post-ictal stage +   Hypoxia during asthma exacerbation despite non-rebreather oxygen mask +   Persistent hypoxia or hypoventilation despite BM   + Partial airway obstruction (laryngeal burn, angio-oedema)   + Cardiopulmonary arrest + +

Indications

Contraindications

Do not perform BM ventilation in the setting of a complete airway obstruction. If this exists, first perform airway clearance and basic life-support manoeuvres. Then attempt foreign-body removal of the obstruction, if necessary, under direct laryngoscopy with Magill forceps.

Equipment