When performed appropriately, bag-mask ventilation is an important intervention in PALS. Proper use requires proper fit; the child’s mouth and nose should be covered tightly, but not the eyes. When possible, use a clear mask since it will allow you to see the color of the patient’s lips and the presence of condensation in the mask indicating exhalation. The two most common types of bag masks are self-inflating and flow-inflating. While a self-inflating bag should be the first choice in resuscitations, it should not be used in infants or children who are spontaneously breathing.
Flow-inflating bags, on the other hand, require more training and experience to operate properly as the provider must manage gas flow, suitable mask seal, patient neck position, and proper tidal volume simultaneously. The minimum size bag should be 450 ml for infants and young children. Older children may require a 1000 ml volume bag. Proper ventilation is of utmost importance as insufficient ventilation leads to respiratory acidosis.