BAG & MASK VENTILATION

Indications

Apneic or gasping following initial steps and tactile stimuloation HR<100/min in a spontaneously breathing baby Spontaneously breathing infant - cyanotic despite free flow oxygen

Contraindications

Diaphragmatic hernia Non -vigorous baby born through meconium stained liquor

Selecting bag & mask equipment

Size of bag (240-750 ml): To deliver a tidal volume of 6-8 ml/kg Oxygen capability: Oxygen source, reservoir Safety feature: Pop off valve, pressure gauge (optional) Mask: Size 0 & 1 (Cover chin, mouth, nose), cushioned edges

Forming seal
Positioning

the infant Position of resuscitator

Forming & checking the seal

Positioning & holding the mask: Enclose chin, mouth & nose, ensure snug seal, avoid pressure over neck and eyes Squeeze the bag with finger tips: Dont squeeze empty the bag with whole hand Observe chest movements: Noticeable rise and fall of chest, shallow and easy breathing

Ventilation rate and pressure

Rate Pressure

: 40-60 breaths/minute Squeeze-two-three-squeeze : Increase in HR &/or Noticeable rise and fall of chest Initial breath: 30-40 cms H2O Later : 15-20 cms H2O

Improvement

Increasing HR

Improving color
Spontaneous breathing

No improvement / deterioration

Chest movement not adequate

Inadequate seal

Reapply mask Reposition Clear secretions Ventilate with open mouth Increasing pressure

Blocked airway

Insufficient pressure

Deterioration

Check oxygen delivery system

Oxygen supply Oxygen tubing

Orogastric catheter

Indication

Need for bag and mask ventilation for over 2 minutes

Technique

Use 6-8 Fr size, measure the length, aspirate gastric contents, leave outer end open

Preterm infants

Avoid excessive chest wall movements (large tidal volume) Monitoring of pressure may help to provide consistent inflations and avoiding unnecessary high pressure CPAP after resuscitation may be helpful

Select bag and connect to oxygen source capable of giving 100% oxygen Select appropriate size mask Test bag Good pressure Pressure release valve working Pressure manometer 30-40 cm H2O

Baby needs Bag and mask ventilation

Position yourself at head end or side of baby Position babys head in sniffing position Position bag and mask properly on baby Check easy chest rise during first two-three breaths

Bag and mask ventilation

Chest Rise Yes No

Check for inadequate seal; reapply face mask

Yes

Chest Rise No

Check for blocked airway. Reposition head, remove secretions, mouth slightly open

Yes

Chest Rise No

Consider insufficient pressure. Increase pressure; consider intubation

Ventilate for 30 seconds Rate 40-60 bpm Increasing HR, visible rise and fall of chest

Check heart rate with stethoscope or umbilical palpation for 6 seconds Less than 6 beats (< 60bpm) 6-10 beats (60-100bpm) More than 10 beats (>100 bpm) Check for spontaneous breathing

Continue ventilation Initiate chest compression Consider intubation

Continue ventilation Consider intubation

No
Continue positive pressure ventilation Consider intubation Consider OG tube insertion Need of post-resuscitation care

Yes
Gradually discontinue positive pressure ventilation Provide tactile stimulation Provide free flow oxygen Need of post-resuscitation care