Does the Number of Fingers on the Bag Influence Volume Delivery? A Randomized Model Study of Bag-Valve-Mask Ventilation in Infants

We sought to compare the effectiveness of two versus five fingers used for bag-valve-mask (BVM) ventilation on effective tidal volume (V(Teff)) delivery in an infant resuscitation model. In a randomised cross-over study, 40 healthcare professionals ventilated a modified leak-free infant resuscitation manikin with both two and five fingers, using a self-inflating bag. The delivered and effective tidal volumes, ventilation rate, and mask leak were measured and recorded using a respiratory function monitor. We found no significant differences in the V(Teff) (five-finger 61.7 ± 23.9 vs. two-finger 58.8 ± 16.6 mL; p = 0.35) or ventilatory minute volume (2.71 ± 1.59 vs. 2.76 ± 1.24 L/min; p = 0.40) of both BVM ventilation techniques. However, there was an increase in the delivered tidal volume (V(Tdel)) and mask leak when using the five-finger technique compared with the two-finger technique (V(Tdel) 96.1 ± 19.4 vs. 87.7 ± 15.5 mL; p < 0.01; and mask leak 34.6 ± 23.0 vs. 30.0 ± 21.0%; p = 0.02). Although the five-finger technique was associated with an increased mask leak, the number of fingers used during the BVM ventilation had no effect on V(Teff) in an infant resuscitation model.