Basic expiratory methods
At the initial stages of resuscitation, expiratory techniques are most commonly used, in which the rescuer blows their own expired air into the victim's airway. The primary technique is the mouth-to-mouth method.
To perform it, the responder positions themselves at the patient's side (if the victim is lying on the ground, kneeling is necessary). The technique involves a strict sequence of actions:
- Ensuring airway patency. One hand is placed under the neck, the other on the forehead, after which the head is tilted back as far as possible.
- Nasal occlusion. The thumb and index finger of the hand resting on the forehead are used to tightly pinch the nostrils.
- Insufflation. The rescuer takes a deep breath, seals their lips tightly around the victim's mouth, and delivers a sharp exhale.
- Passive exhalation. The rescuer must pull back from the patient's face and wait for the chest to lower on its own.
The optimal tidal volume (TV) in this case ranges from 500 to 700 ml, and the respiratory rate (RR) is 12–18 cycles per minute. The only reliable criterion for the effectiveness of the manipulation is visible chest excursion: the chest should rise during inspiration and fall during expiration.
In situations where the patient has traumatic injuries to the mandible or presents with trismus (severely clenched jaws), the mouth-to-nose method is used. In this case, one hand also tilts the head back via the forehead, while the other grasps the lower jaw and presses it tightly against the upper jaw, closing the mouth. Insufflation is performed into the victim's nose.
Ventilation features in neonates
Resuscitation of infants has significant differences due to their anatomical and physiological characteristics. The combined mouth-to-mouth and nose method is used for them.
The infant's head is also tilted back. The responder must simultaneously and securely cover both the infant's mouth and nose with their own mouth, then perform the insufflation.
The key difference lies in the ventilation parameters. Due to the small lung volume, the tidal volume is only 30 ml. At the same time, the respiratory rate must be significantly higher than in adults—from 25 to 30 cycles per minute.
Instrumental ventilation methods
To prevent airway obstruction and tongue drop, an S-shaped tube (airway) is often used. Proper insertion of the airway requires care: it is introduced into the oral cavity with the curved end pointing upward, sliding along the hard palate. Upon reaching the level of the tongue base, the tube is rotated 180° around its axis. The special flange on the tube must seal the mouth tightly. During ventilation through the airway, the patient's nose must be pinched, and exhalation is carried out through the open lumen of the tube.
A more advanced instrumental method is the use of a facemask with a bag-valve-mask (Ambu bag). When using it, the patient's head must also be tilted back. The mask is positioned so that it covers the mouth and nose.
Proper finger placement to secure the device is extremely vital:
- The thumb (I) holds the narrow nasal portion.
- The index finger (II) secures the lower part of the mask.
- The middle, ring, and little fingers (digits III, IV, V) lift the mandible upward.
Inhalation is ensured by rhythmic compression of the bag. Exhalation occurs passively through a special valve that vents air into the atmosphere. If necessary, oxygen can be connected to this system.
Precautions
When performing artificial pulmonary ventilation using direct contact methods ("mouth-to-mouth" or "mouth-to-nose"), there is a risk of infection for the rescuer. For prevention purposes, before starting insufflations, a barrier material—such as clean gauze or a handkerchief—must be placed between the rescuer's mouth and the patient's face.
Briefly: answers to topical questions
What actions comprise the triple airway maneuver?
The triple airway maneuver consists of three actions:
- head tilt — extension of the cervical spine;
- jaw thrust — traction of the jaw forward and upward;
- opening the mouth.
What are the contraindications for the mouth-to-mouth ventilation method?
The sources do not explicitly describe contraindications for mouth-to-mouth ventilation. Indications for the mouth-to-nose method are specified instead:
- traumatic injuries of the mandible;
- severely clenched jaws (trismus).
What complications can occur during BVM (Ambu bag) mask ventilation?
During BVM mask ventilation lasting more than 3–5 minutes, air inevitably enters the stomach, which requires the insertion of a nasogastric tube. Sources also describe aspiration and regurgitation as complications associated with vomiting and regurgitation, but their direct connection to gastric inflation during mask ventilation is not specified.
How is the Sellick maneuver performed during ventilation?
The Sellick maneuver is performed by applying backward pressure on the cricoid cartilage to compress the esophagus.
The execution technique includes the following features:
- Force — pressure on the cartilage is applied with a force of 10 N to 30 N.
- Start time — performed at the stage of mask ventilation from the moment the patient loses consciousness.
- End — pressure is maintained until correct tube placement and cuff inflation are confirmed.
Class and exam questions
How to determine that ventilation is being performed effectively?
The main criterion for effectiveness is chest excursion. The chest should visibly expand during air insufflation and deflate during passive exhalation.
In what cases is mouth-to-mouth breathing prohibited?
This method is not used in cases of severely clenched jaws (trismus) or traumatic injuries of the lower jaw. In such cases, switching to mouth-to-nose breathing is indicated.
How to properly insert an airway?
The S-shaped tube is inserted with the curved end pointing upward along the hard palate. At the level of the tongue base, it must be rotated 180 degrees around its axis.
What else to study on this topic
- Measures of stage I cardiopulmonary resuscitation
- Compression techniques of basic cardiopulmonary resuscitation
- Placement of an endotracheal tube and laryngoscope
- Connecting oxygen to the Ambu bag
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