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Bag-valve-mask (BVM) ventilation is a manual resuscitation technique that provides positive pressure ventilation to patients with inadequate or absent spontaneous breathing. This procedure uses a self-inflating bag connected to a one-way valve and a face mask to deliver ambient air or supplemental oxygen when compressed. BVM ventilation is a vital intervention in both prehospital and in-hospital settings for patients experiencing respiratory failure, cardiac arrest, or undergoing anesthesia induction. Indications for BVM ventilation include apnea, severe hypoventilation, and ineffective respiratory effort. Relative contraindications include complete upper airway obstruction and facial trauma that prevents an adequate mask seal. Proper technique involves maintaining a patent airway, achieving a secure mask seal, and delivering ventilations that produce visible chest rise. Signs of inadequate ventilation—such as gastric insufflation, absent chest rise, or decreasing oxygen saturation—should prompt immediate reassessment of patient positioning and technique. This activity provides healthcare professionals with the essential skills to perform BVM ventilation and to identify patients who may benefit from this lifesaving intervention. This activity also reviews the clinical indications and contraindications for BVM use and emphasizes proper techniques to ensure adequate ventilation. Additionally, this activity highlights the importance of interprofessional collaboration in optimizing care for individuals experiencing respiratory distress. Objectives: Identify the clinical indications and contraindications for initiating bag-valve-mask ventilation in emergency and perioperative settings. Implement correct bag-valve-mask techniques, including proper mask seal, head positioning, and ventilation rates to ensure effective oxygen delivery. Apply the head tilt–chin lift or jaw thrust maneuver appropriately to optimize airway alignment and minimize airway obstruction. Collaborate with interprofessional healthcare team members to perform the bag-valve-mask ventilation technique to maintain an adequate mask seal and airway, thereby facilitating positive patient outcomes. Access free multiple choice questions on this topic.

Bag-valve-mask (BVM) ventilation is a critical skill for emergency care providers. Proficiency requires consistent practice, as this technique is commonly used in urgent and life-threatening situations. Effective ventilation depends on proper patient positioning. Without it, the tongue can fall back against the pharynx, potentially obstructing the airway. The head tilt–chin lift or jaw thrust maneuver is crucial for maintaining airway patency (see Image. Head Tilt–Chin Lift Maneuver). The "sniffing" position, achieved by flexing the neck forward and aligning the sternal notch with the angle of the mandible, facilitates airway opening. An oropharyngeal (OPA) or nasopharyngeal (NPA) airway may also be used to maintain an open airway. In addition to facilitating airway patency, the sniffing position enhances glottic visualization and increases first-pass success during endotracheal intubation. BVM devices typically include a one-way or pressure-release valve and require a high-flow oxygen source to deliver oxygen effectively to the patient.[1][2][3][4]

Complications of BVM ventilation include barotrauma from excessive lung inflation and gastric insufflation, which can lead to vomiting and aspiration. Hyperventilation reduces exhalation time and may cause pulmonary barotrauma, such as pneumothorax and arterial gas embolism. Because BVM ventilation delivers positive pressure ventilation, hyperventilation also raises intrathoracic pressure, decreasing central venous return to the heart, reducing right ventricular preload, and impairing effective cardiac resuscitation.

BVM ventilation is a vital technique for managing respiratory distress and is commonly used by emergency medical services personnel, anesthesiologists, intensive care nurses, respiratory therapists, and intensivists. This lifesaving procedure is often easier than intubation and, when performed correctly, provides effective oxygenation until an anesthesiologist can secure the airway. An interprofessional approach is essential to ensure optimal patient care.

A team approach facilitates the two-person application of BVM ventilation, while other team members prepare for definitive airway management, such as rapid sequence intubation. Additional nursing responsibilities include monitoring pulse oximetry and electrocardiogram (ECG) telemetry, establishing intravenous access, obtaining blood samples for gas analysis, administering medications, setting up and operating suction, maintaining accurate records, and coordinating necessary resources.