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

The European Resuscitation Council has recommended decreasing tidal volume during basic life support ventilation from 800 to 1200 ml, as recommended b y the American Heart Association, to 500 ml in order to minimise stomach in flation. However, if oxygen is not available at the scene of an emergency, and small tidal volumes are given during basic life support ventilation wit h 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 paediatr ic (maximum volume, 700 ml:) self-inflatable bag for 5 min before intubatio n. When using an adult (n = 20) versus paediatric (n = 20) self-inflatable bag, mean +/- SEM tidal volumes and tidal volumes per kilogram were signifi cantly (P < 0.0001) larger (719 +/- 22 vs. 455 +/- 23 ml and 10.5 +/- 0.4 v s. 6.2 +/- 0.4 ml kg(-1), respectively). Compared with an adult self-inflat able 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 smalle r tidal volumes of approximate to 6 ml kg(-1) (approximate to 500 ml) given with a paediatric self-inflatable bag and room-air maintain adequate carbo n dioxide elimination, but do not result in sufficient oxygenation during b ag-valve-mask ventilation. Thus, if small (16 ml kg(-1)) tidal volumes are being used during bag-valve-mask ventilation, additional oxygen is necessar y. Accordingly, when additional oxygen during bag-valve-mask ventilation is not available, only large tidal volumes of approximate to 11 ml kg(-1) wer e able to maintain both sufficient oxygenation and carbon dioxide eliminati on. (C) 2000 Elsevier Science Ireland I,td. All rights reserved.