Introduction
Continuous manual ventilation is also called a bag-valve-mask or BBM ventilation. It is a method that gives respiratory support to the patient who has difficulty breathing or not breathing at all. In this method, a bag is attached to a mask that will cover the mouth and nose of a person, and it is manually squeezed, forcing the air into the lungs. It is used in emergency situations like respiratory arrest, severe respiratory distress, and cardiac arrest. Trained bystanders or healthcare professionals can perform it.
The activity of continuous manual ventilation depends on the experience and skill of the people performing it. It also depends upon the mask fitting and size of the mask. It is important to evaluate the person's breathing pattern and adjust the rate and depth of the ventilation to avoid under-ventilation or over-ventilation that can lead to complications like hypoxia (less oxygen in the tissues) or hyperventilation (the rate of breathing is increased with the help of machine).
When Is Continuous Manual Ventilation Used?
Continuous manual ventilation is used in cases where a person is not breathing properly or has stopped breathing, and the ventilation and oxygenation need support immediately. This can include various cases like:
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Cardiac Arrest - In case of cardiac arrest, there will be a stoppage of the heart, then the breathing process will also stop. In such cases, immediate CPR or cardiopulmonary resuscitation is essential. Along with chest compression, continuous manual ventilation is used to maintain ventilation and oxygenation.
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Respiratory Arrest - In case of severe asthma, drowning, or drug overdose, sometimes the patient stops breathing due to respiratory system failure. In such cases, continuous manual ventilation is used to support breathing until an advanced intervention is performed.
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Severe Respiratory Distress - In severe respiratory distress, like acute respiratory distress syndrome (ARDS), pneumonia, or acute exacerbation of chronic obstructive pulmonary disease (COPD), continuous manual ventilation helps in supporting the breathing of the patient until an advanced intervention is performed.
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Anesthesia - Continuous manual ventilation is used to give ventilation and oxygenation in patients who are under general anesthesia during a surgical procedure.
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Trauma - In severe trauma cases like spinal cord injury, chest trauma, or head injury, continuous manual ventilation is used to assist the breathing of the patient until a more definitive intervention is performed.
What Is the Mechanism for the Delivery of Continuous Manual Ventilation?
The continuous manual ventilation works by delivering air and oxygen manually to the lungs of the patient with the help of a bag-valve-mask device. The continuous manual ventilation device contains a self-inflating bag attached to a face mask and an oxygen delivery system. In order to perform the continuous manual ventilation method, the patient is first positioned with their head in a neutral position to give proper alignment of the airway. After that, the face mask is placed over the nose and mouth of the patient and will create an artificial seal. Then the trained individual or the healthcare professional squeezes the self-inflating bag, which delivers oxygen into the patient's lungs. The bag gets refilled passively, which allows the patient to exhale. This squeezing and refilling cycle is repeated for 10 to 12 breaths per minute in adults.
During this procedure, the patient's breathing is monitored, and the depth and rate of the ventilation are adjusted accordingly to avoid under-ventilation or over-ventilation, which can lead to complications like hypoxia or hyperventilation. The patient's response to the ventilation is also noted, like chest movements, oxygen saturation, and respiratory rate.
Which Are the Techniques for Performing Continuous Manual Ventilation?
There is a proper technique for delivering continuous manual ventilation to ensure the effective flow of oxygen and ventilation. Some of the general steps followed during continuous manual ventilation include the following:
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The head of the patient should be in a neutral position which will help in giving a proper alignment of the airway.
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The face mask will be placed over the mouth and nose of the patient, which will create an airtight seal. In order to give a good seal, the appropriate size of the mask should be selected.
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The trained individual or health care professional will squeeze the self-inflating bag, delivering air and oxygen to the patient's lungs. It should be squeezed accordingly, which will provide adequate ventilation but should not cause any discomfort or injury to the lungs.
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The bag gets passively refilled by itself, allowing the patient to exhale.
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The squeezing and refilling are repeated at the rate of approximately 10 to 12 breaths per minute.
What Are the Advantages of Continuous Manual Ventilation?
The advantages of continuous manual ventilation include the following:
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Continuous manual ventilation will give immediate or rapid support of breathing and allows rapid ventilation and oxygenation.
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Continuous manual ventilation is a simple and low-cost device that can be used in various settings like emergency departments, pre-hospital, and in-patient settings.
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This portable device can be easily transported, making it useful during patient transport and emergencies.
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They can be used for various clinical scenarios for a wide range of patients like infants, children, and adults.
What Are the Disadvantages of Continuous Manual Ventilation?
The disadvantages or limitations of continuous manual ventilation include the following:
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This technique's effectiveness depends on the operator's experience and skill. Improper technique can sometimes result in certain complications.
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Overventilation can result in hyperventilation, and underventilation can result in hypoxia. So regular monitoring and adjustment of the rate and depth of ventilation are needed to avoid these complications.
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It provides only limited ventilation support. Some cases need advanced mechanical ventilation.
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Improper use of this technique will result in injury to the airway, like pneumothorax (when air leaks into the area or space between the chest wall and the lungs) or gastric insufflation (during emergency pulmonary ventilation, sometimes there will be blowing of air into the stomach due to over-inflation of the lungs).
What Are the Potential Risks and Complications Associated With Continuous Manual Ventilation?
Some of the potential risks and complications associated with continuous manual ventilation include the following:
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Over-ventilation will decrease carbon dioxide in the blood and lead to confusion, seizures, dizziness, and cardiac arrest.
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If the ventilation rate is too high, it will result in hyperventilation and a decrease in the carbon dioxide level in the blood.
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If the ventilation rate is too low, it can result in hypoxia or decreased oxygen level and cause organ failure or tissue damage.
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If an excessive amount of air enters the patient's stomach, it can result in gastric insufflation, which is associated with aspiration, vomiting, and gastrointestinal complications.
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Improper technique can result in airway injuries, like vocal cord damage or even pneumothorax.
Conclusion
Continuous manual ventilation is a lifesaving technique that gives emergency oxygenation and ventilation in various cases. It will give respiratory support to people who have difficulty breathing. People giving continuous manual ventilation should be trained enough to deliver the technique to give effective and safe ventilation. It has many advantages and disadvantages associated with potential risks and complications.
