What should be the next step if a patient's oxygen saturation and respiratory effort do not improve after bagging?

When a patient’s oxygen saturation and respiratory effort fail to improve after manual bagging, it indicates that the current intervention is insufficient to ensure adequate ventilation and oxygenation. In this critical situation, the most appropriate next step is to prepare for intubation.

Intubation provides a secure airway and facilitates direct ventilation of the lungs, ensuring that oxygen can be delivered effectively. After bagging, if the patient does not respond positively by improving their oxygen saturation or respiratory effort, it indicates a possible advanced airway issue or severe respiratory failure that requires a more definitive intervention than bagging alone.

While administering supplemental oxygen can be beneficial in improving oxygen saturation, it would not adequately address the underlying issue if the patient is unable to ventilate effectively. Increasing the ventilation rate might also temporarily assist, but if the bagging is ineffective, simply increasing the rate could lead to further complications without resolving the problem. Observing for further distress without taking decisive action could jeopardize the patient's safety and worsen the clinical situation.

Thus, preparing to intubate becomes the critical next step in ensuring the patient receives the necessary airway support and ventilation.