Should the Mask Be Sealed?
Yes, oxygen masks used for bag-mask ventilation must be tightly sealed to the patient's face to deliver effective ventilation. 1
Bag-Mask Ventilation Requirements
Effective bag-mask ventilation absolutely requires a tight seal between the mask and the victim's face. 1 The American Heart Association explicitly states this as a fundamental requirement for successful ventilation during resuscitation. 1
Proper Sealing Technique
- Open the airway by lifting the jaw toward the mask to create a tight seal, then squeeze the bag until the chest rises. 1
- The two-person technique is preferred because one rescuer uses both hands to open the airway and maintain a tight mask-to-face seal while the other compresses the bag. 1, 2
- The EC-clamp technique is effective: three fingers lift the jaw (forming an "E") while the thumb and index finger hold the mask to the face (making a "C"). 2
Troubleshooting Poor Seal
If the chest does not rise during ventilation, immediately verify that there is a tight seal between the mask and the face, reopen the airway, and reattempt ventilation. 1 This is the first corrective action recommended by the American Heart Association when ventilation appears inadequate. 1
High-Risk Surgical Situations
For procedures involving moderate or deep sedation with an ignition source near the face, head, or neck, the American Society of Anesthesiologists recommends considering a sealed gas delivery device (e.g., cuffed tracheal tube or laryngeal mask) to prevent fire risk. 1 This represents a different context where "sealed" refers to protecting the airway from oxygen accumulation in the surgical field.
Non-Rebreather Masks
Non-rebreather masks used for spontaneous breathing patients should be tight-fitting to deliver higher oxygen concentrations (60-80%). 1 The American Heart Association specifies using a tight-fitting nonrebreathing mask with oxygen inflow of approximately 15 L/min. 1
Critical Distinction
The requirement for a tight seal applies specifically to bag-mask ventilation during resuscitation or assisted ventilation. 1, 2 A two-person technique may be required when there is difficulty creating a tight seal between the mask and the face. 1