The Management of Respiratory Failure: Airway Management and Manual Methods of Artificial Ventilation

Abstract

This chapter concerns emergency airway management and manual methods of artificial ventilation using both the basic technique of expired air ventilation and the bag–valve (BV) device. The former is part of primary cardiopulmonary resuscitation. The latter is widely used in emergency medicine and if used correctly can provide effective artificial ventilation over a limited period. The device is recommended for use in resuscitation by international resuscitation guidelines which set out the appropriate tidal volumes and rates of ventilation to be used. However there are recognized dangers in using a BV device. There is increasing evidence to show the considerable variation of ventilation, when it is used in emergency ventilation. In particular, high inflation pressures and large tidal volumes may be delivered which can cause barotraumas and volutrauma, as well as gastric insufflation if the device is being used without a protected airway. Equally, hypoinflation may occur leading to hypoxia.

There is a need for greater awareness of the potential problems of intermittent positive pressure ventilation in emergency. To achieve this, better training is required. Compared with airway management, which is taught to a high skill level in most emergency services, the correct use of the bag valve device has not received the same attention. Many of the problems associated with the use of the BV can be overcome by use of portable automatic ventilators which are increasingly used by emergency services in parallel with bag ventilation. The function and use of portable ventilators is the subject of the next chapter.