Bag-mask ventilation as a temporizing measure in acute infectious upper-airway obstruction: does it really work?

Jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute infectious upper-airway obstruction (AIUAO). It is the treatment of choice for patients on the way to hospital or in an emergency department until definitive stabilization is achieved with available resources. We report three fatal case studies showing ineffective bag-mask ventilation in AIUAO that raise concerns over this treatment. Case 1 is a 4-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 2 is a 3-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 3 is a 3-year-old child with viral laryngotracheitis and respiratory arrest just after the admission. Should the approach of bag-mask ventilation in AIUAO change to ventilate patients in the prone position? This approach offers two advantages. First, gravity helps the epiglottis fall forward, reducing the airway obstructions. Second, if the patient vomits during ventilation, the vomit will fall to the floor. During bag-mask ventilation in patients with severe partial airway obstruction, ventilation pressure is high. Gastric inflation may occur and rapidly distend the stomach. This gastric distension interferes with ventilation by elevating the diaphragm, resulting in a decreased lung volume. Cricoid pressure could prevent gastric distension in these instances and should be recommended.