Smaller tidal volumes with room-air are not sufficient to ensure adequate oxygenation during bag–valve–mask ventilation

Abstract

The European Resuscitation Council has recommended decreasing tidal volume during basic life support ventilation from 800 to 1200 ml, as recommended by the American Heart Association, to 500 ml in order to minimise stomach inflation. However, if oxygen is not available at the scene of an emergency, and small tidal volumes are given during basic life support ventilation with a paediatric self-inflatable bag and room-air (21% oxygen), insufficient oxygenation and/or inadequate ventilation may result. When apnoea occurred after induction of anaesthesia, 40 patients were randomly allocated to room-air ventilation with either an adult (maximum volume, 1500 ml) or paediatric (maximum volume, 700 ml) self-inflatable bag for 5 min before intubation. When using an adult ( n=20) versus paediatric ( n=20) self-inflatable bag, mean ±SEM tidal volumes and tidal volumes per kilogram were significantly ( P<0.0001) larger (719±22 vs. 455±23 ml and 10.5±0.4 vs. 6.2±0.4 ml kg −1, respectively). Compared with an adult self-inflatable bag, bag–valve–mask ventilation with room-air using a paediatric self-inflatable bag resulted in significantly ( P<0.01) lower paO 2 values (73±4 vs. 87±4 mmHg), but comparable carbon dioxide elimination (40±2 vs. 37±1 mmHg; NS). In conclusion, our results indicate that smaller tidal volumes of ≈6 ml kg −1 (≈500 ml) given with a paediatric self-inflatable bag and room-air maintain adequate carbon dioxide elimination, but do not result in sufficient oxygenation during bag–valve–mask ventilation. Thus, if small (6 ml kg −1) tidal volumes are being used during bag–valve–mask ventilation, additional oxygen is necessary. Accordingly, when additional oxygen during bag–valve–mask ventilation is not available, only large tidal volumes of ≈11 ml kg −1 were able to maintain both sufficient oxygenation and carbon dioxide elimination.