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You are managing a 1yo patient with submersion injury who has respiratory distress and falling O2 saturation. You begin bag-valve-mask ventilation as you prepare to intubate the patient, using a 450mL self-inflating bag with oxygen at 10 L/minute, bagging at a rate of 20 breaths/minute. You note that the patient is not improving and there is poor chest rise, so you insert a correctly sized and placed nasopharyngeal airway. The patient is still not improving and has poor chest rise – after repositioning, which is the best intervention?
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November 24, 2020 at 7:52 pm
C) Depress the pop-off valve
Pediatric BVMs often have pop-off valves designed to limit the maximum positive inspiratory pressure one can give (usually limited to 35-40 cm H2O) to avoid barotrauma. In a patient that has significant airspace disease and requires high pressures to inflate the lungs, one may need to depress the pop-off valve to override this limitation on maximal pressures. A 1yo patient should not need an adult-sized 1000mL bag. Increasing the oxygen inspired and the ventilatory rate will not help if you are not achieving good chest rise. A correctly sized and placed nasopharyngeal airway should not be interfering with BVM.