Bag valve mask 1

Bag valve mask

A bag valve mask (also known as a BVM
or Ambu bag) is a hand-held device used to
provide positive pressure ventilation to a
patient who is not breathing or who is
breathing inadequately. The device is a
normal part of a resuscitation kit for trained
professionals, such as ambulance crew. The
BVM is frequently used in hospitals, and is
an essential part of a crash cart. The device
is used extensively in the operating room to
ventilate an anaesthetised patient in the
minutes before a mechanical ventilator is
attached. The device is self-filling with air,
although additional oxygen (O2) can be
added. A disposable BVM Resuscitator

Use of the BVM to ventilate a patient is

frequently called "bagging" the patient.[1] Bagging is regularly necessary in medical emergencies when the patient's
breathing is insufficient (respiratory failure) or has ceased completely (respiratory arrest). The BVM resuscitator is
used in order to manually provide mechanical ventilation in preference to mouth-to-mouth resuscitation (either direct
or through an adjunct such as a pocket mask).

Components
The BVM consists of a flexible air chamber, about the size of a rugby
ball, attached to a face mask via a shutter valve. When the air chamber
or "bag" is squeezed, the device forces air through into the patient's
lungs; when the bag is released, it self-inflates, drawing in ambient air
or a low pressure oxygen flow supplied from a regulated cylinder,
while the patient's lungs deflate to the air through the one way valve.

Bag and valve combinations can also be attached to an alternate airway

adjunct, such as an endotracheal tube or laryngeal mask airway. Often
The Ambu Resuscitator bag or BVM, this version
a small HME filter (Heat & Moisture exchanger, or humidifying /
shows is a hybrid MkIII body, Mark IV head and
bacterial filter) is used. with an old obsolete latex inflatable seal on the
mask. The part labelled 1 is a flexible mask
A bag valve mask can be used without being attached to an oxygen
designed to seal to the patient's face, and the part
tank to provide air to the patient, often called "room air" in the U.S. labelled 3 is a self-filling bag, i.e. re-fills as an
Supplemental oxygen increases the partial pressure of oxygen inhaled, action of the elastic re-coil of the bag after
helping to increase perfusion in the patient. compression.

Most devices also have a reservoir which can fill with oxygen while
the patient is exhaling (a process which happens passively), in order to increase the amount of oxygen that can be
delivered to the patient to nearly 100%.[2]
Bag valve masks come in different sizes to fit infants, children, and adults.
Most types of the device are disposable and therefore single use, while others are designed to be cleaned and reused.
Bag valve mask 2

Method of operation
The BVM directs the gas inside it via a one-way valve when compressed by a rescuer; the gas is then delivered
through a mask and into the patient's trachea, bronchus and into the lungs. In order to be effective, a bag valve mask
must deliver between 500 and 800 milliliters of air to the patient's lungs, but if oxygen is provided through the tubing
and if the patient's chest rises with each inhalation (indicating that adequate amounts of air are reaching the lungs),
400 to 600 ml may still be adequate.[1] Squeezing the bag once every 5 seconds for an adult or once every 3 seconds
for an infant or child provides an adequate respiratory rate (12 respirations per minute in an adult and 20 per minute
in a child or infant).[3]
Professional rescuers are taught to ensure that the mask portion of the BVM is properly sealed around the patient's
face (that is, to ensure proper "mask seal"); otherwise, air escapes from the mask and is not pushed into the lungs. In
order to maintain this protocol, some protocols use a method of ventilation involving two rescuers: one rescuer to
hold the mask to the patient's face with both hands and ensure a mask seal, while the other squeezes the bag.[4]
However, as most ambulances have only two members of crew, the other crew member is likely to be doing
compressions in the case of CPR, or may be performing other interventions such as defibrillation or cannulation. In
this case, or if no other options are available, the BVM can also be operated by a single rescuer who holds the mask
to the patient's face with one hand, in the anaesthetists grip, and squeezes the bag with the other.
When using a BVM, as with other methods of positive pressure ventilation, there is a risk of over-inflating the lungs.
This can lead to pressure damage to the lungs themselves, and can also cause air to enter the stomach, causing gastric
distention which can make it more difficult to inflate the lungs and which can cause the patient to vomit. This can be
avoided by care on behalf of the rescuer. Alternatively, some models of BVM (usually Paediatric) are fitted with a
valve which prevents over inflation, by venting the pressure when a pre-set pressure is reached. Nevertheless, cricoid
pressure should be applied whenever possible until the patient is intubated or until ventilations have ceased.
An endotracheal tube (ETT) can be inserted by a trained practitioner and can substitute for the mask portion of the
BVM. This provides a more secure fit and is easier to manage during emergency transport, since the ET tube is
sealed with an inflatable cuff in the trachea, so that any regurgitation cannot enter the lungs. Such material can
severely damage the lung tissue, and in the absence of an ET tube, could choke the patient by obstructing the airway.
Inhalation of stomach contents can be fatal; the after effects can cause Mendelson's syndrome or aspiration
pneumonia.
Some rescuers may also choose to use a different form of resuscitation adjunt, such as an oropharyngeal airway or
Laryngeal mask airway, which would be inserted and then used with the BVM.
In a hospital, long-term mechanical ventilation is provided by using more complex devices such as an intensive care
ventilator, rather than by a BVM, which requires at least one person to operate it constantly.
A flow-restricted, oxygen-powered ventilation device (FROPVD) is similar to a BVM in that oxygen is pushed
through a mask into the patient's lungs, but unlike a BVM, in the FROPVD the pressure needed to push air into the
patient's lungs is generated by oxygen via a pressure regulator from a cylinder rather than by squeezing a bag.

Ambu bag
One proprietary brand of a self-inflating BVM resuscitator is called the Ambu bag. The concept for the original
Ambu bag was developed in 1953 by the German engineer, Dr. Holger Hesse, and his partner, Danish anaesthetist
Henning Ruben. In 1956, the world's first non-electric, self-inflating resuscitator was ready for production by their
company, Ambu A/S, which still produces a wide range of single-patient and multi-use resuscitators. The Ambu
name has become an example of a Genericized trademark, as all manual bag resuscitators in medical settings are
now often referred to generically as "Ambu bags," even though Ambu brand resuscitator bags are still produced and
other companies are not allowed to use the Ambu trademark.
Bag valve mask 3

See also
• Mechanical ventilation
• Artificial respiration

External links
• A free transparent reality simulation of the self-inflating manual resuscitator ("Ambu" bag) [5]

References
[1] Daniel Limmer and Michael F. O'Keefe. 2005. Emergency Care 10th ed. Edward T. Dickinson, Ed. Pearson, Prentice Hall. Upper Saddle
River, New Jersey. Page 140.
[2] Stoy, Walt (2004) (PDF). Mosby's EMT-Basic Textbook (http:/ / www3. us. elsevierhealth. com/ promo/ Stoy/ pdfs/ ch8. pdf). Mosby/JEMS.
ISBN 0323034381. .
[3] Emergency Care, Pages 142-3
[4] Emergency Care, Page 141.
[5] http:/ / vam. anest. ufl. edu/ checkout/ check-sirb. html
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