Paediatrics: Mask ventilation

Mask ventilation

This procedure is useful during resuscitation or for short periods of as-sisted ventilation. It can be performed using a self-inflating bag and face mask with an appropriately-sized reservoir bag; alternatively, use a mask connected to a ‘T’ piece and a continuous supply of gas, as well as a pressure-limiting device. In the latter, a breath is given by occluding the open aperture of the ‘T’ piece.

Procedure

• Ensure patent airway.

• Select appropriate size mask. It should be big enough to be able to cover the face from the bridge of the nose to below the mouth, but not extend over the edge of the chin or over the orbits. In infants a round mask, e.g. Laerdal^® or Bennett’s mask, is most appropriate. In older children the Laerdal^® moulded mask is more suitable.

• Connect face mask to an appropriate self-inflating bag or tubing with a ‘T’ piece and then to an oxygen or air supply at an adequate flow rate, e.g. 5–8L/min in the newborn.

• In newborns, a pressure-limiting valve should used and initially be set at 725–30cmH₂O.

• Apply mask to face over mouth and nose, and apply enough downward pressure to make an effective seal.

• Give inflation breaths by either compressing self-inflating bag or occluding open aperture of ‘T’ piece.

• Observe and ausculate chest wall for adequate inflation. Note whether condition of child is improving or deteriorating.

• If inflation is poor or child deteriorating, check airway is not obstructed and use one or more techniques to ensure patent airway.

Prolonged mask ventilation is likely to lead to a distended stomach. Insert an oro-gastric tube on free drainage to decompress the stomach and pre-vent diaphragmatic splinting.