During BVM ventilation, which of the following indicates ongoing ventilation?

• A. No chest rise and silent breaths
• B. Chest rise but no breath sounds
• C. Rapid bag compression without chest movement
• D. Visible chest rise and equal breath sounds with improving SpO2/ETCO2

Answer: (D)

Ongoing ventilation during bag-valve-mask use is shown when air actually reaches the lungs and gas exchange improves. You should see visible chest rise with each squeeze, indicating air is entering the chest. Equal breath sounds on both sides suggest air is being distributed to both lungs rather than escaping or entering a blocked or nonfunctional airway. In addition, objective signs that ventilation is working include improving oxygen saturation (SpO2) and a proper capnography readout (ETCO2), which together show that oxygen is being taken up and CO2 is being expelled.

If there’s no chest rise and no breath sounds, there’s no effective ventilation happening. If the chest rises but there are no breath sounds, air may be escaping or the airway may be obstructed, meaning ventilation is not adequately reaching the lungs. If you’re compressing the bag rapidly but there’s no chest movement, air isn’t moving into the lungs, signaling a problem with airway patency or seal. The combination of visible chest rise, equal breath sounds, and improving SpO2/ETCO2 best indicates that ventilation is ongoing and effective.