The self-inflating manual resuscitation bag (Bag Valve Mask) is used to provide ventilation and oxygenation to a patient with or without an artificial airway in place. The device automatically re-expands between breaths and can be used with room air or can be connected to an oxygen source.

Manual ventilation with an manual resuscitation bag is an essential skill in emergency situations, such as respiratory distress and cardiopulmonary arrest. It is sometimes referred to a bagging. Manual ventilation is also indicated for transporting patients who are supported by mechanical ventilation and assessing airway patency and proper artificial airway device placement.

In the mechanically ventilated patient, manual ventilation is done using an artificial airway, such as an endotracheal or tracheostomy tube. Manual ventilation should result in the rise and fall of the chest and auscultatory evidence of bilateral air entry.

When signs and symptoms of respiratory distress are observed in a patient requiring mechanical ventilation and troubleshooting the ventilator does not solve the problem, the patient should be manually ventilation with manual resuscitation bag attached to a 100% oxygen source.

When manual ventilation is required during transport, a procedure designed to provide a ventilatory pattern similar to the one provided by the ventilator should be used. Portable ventilators are highly recommended during patient transport.

When manually ventilating a patient, it's important to monitor the rate and depth of ventilations. Large manual breaths or rapid rates during manual ventilation may result in dynamic hyperinflation and resultant hypotension. Dynamic hyperinflation is most commonly associated with bronchospasm and chronic obstructive pulmonary disease. A high index of suspicion is necessary for the presence of dynamic hyperinflation if hemodynamic instability or worsening respiratory distress occurs with bagging.

Hyperinflation occurs when exhalation time is inadequate, which results in auto positive end-expiratory pressure (PEEP). Auto PEEP increases intrathoracic pressures and may decrease venous return, which may result in hypotension. It may also result in significant barotrauma and the possibility of pneumothorax or tension pneumothorax. A rapid solution to auto PEEP with hemodynamic or respiratory compromise is a brief disconnection from the bag to allow passive deflation and a decrease in intrathoracic pressures. This should result in improved hemodynamics. With resumption of bagging, providing a longer exhalation time (smaller tidal volumes with a lower respiratory rate) will help to minimize auto PEEP.