A prospective, up-down sequential allocation study investigating the effectiveness of vital capacity breaths using high-flow nasal oxygenation versus a tight-fitting face mask to pre-oxygenate term pregnant women

Al-Sulttan, S.; Bampoe, Sohail; Howle, Ryan; Setty, T.; Columb, Malachy O.; Patel, Avnish; Fernando, Roshan; Husain, Tauqeer; Sultan, Pervez

doi:10.1016/j.ijoa.2020.08.004

Cited by 19 publications

(7 citation statements)

References 32 publications

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“…The studies of Au K et al and AI Sulttan S et al Showed that compared with FMV, the preoxygenation efficiency of HFNO in pregnant women was lower than that in FMV group, and Tan PCF et al's study showed that after 3 minutes preoxygenation of HFNO in pregnant women, the proportion of EtO2 reaching 90% was only 60%, which was lower than that of FMV in previous studies. [34][35][36] However, a modelling investigation by Stolady et al showed that despite generating lower EtO2, continuous application of HFNO could provide longer safe apnoea time in pregnant subjects in labour. [37] In our study, meta analysis showed that there was no significant difference(p=0.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of High-Flow Nasal Oxygen vs. Standard Facemask Oxygenation for pre- and apneic oxygenation during Anesthesia Induction: A Systematic Review and Meta-analysis

Song

Sun

Shi

et al. 2021

Preprint

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BackgroundIn recent years, high flow nasal oxygen(HFNO) has been widely used in clinic, especially in perioperative period.Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial.Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis ofRCTs.MethodsEMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevantrandomized controlled trails(RCTs) on the effectiveness of HFNO versus standard facemask ventilation(FMV) inpre- and apenic oxygenation. Studies involving one of the following six indicators: (1)Arterial oxygen partialpressure(PaO2), (2)End expiratory oxygen concentration(EtO2), (3)Safe apnoea time, (4)Minimum pulse oxygensaturation(SpO2min), (5)Oxygenation(O2) desaturation, (6)End expiratory carbon dioxide(EtCO2) or Arterial carbondioxide partial pressure(PaCO2) were included. We select random effect model or fixed effect model for analysisaccording to the heterogeneity of the article, and express it as the mean difference(MD) or risk ratio(RR) with aconfidence interval of 95%(95%CI). We conducted a risk assessment of bias for eligible studies and assessed theoverall quality of evidence for each outcome.Results14 RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMVgroup with a MD(95% CI) of 57.38 mmHg(25.65 to 89.10; p=0.0004) after preoxygenation and the safe apnoeatime was significantly longer with a MD(95% CI) of 86.93 seconds(44.35 to 129.51; p<0.0001) during anesthesiainduction. There were no significant statistical difference in the minimum O2 saturation, CO2 accumulation, endexpiratory oxygen concentration and O2 desaturation rate during anesthesia induction between the two groups.ConclusionsThis systematic review and meta-analysis suggests that HFNO should be considered as an airway managementtool for patients with high-risk hypoxemia or difficult airway during anesthesia induction. Compared with FMV,continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safeapnoea time in surgical patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of High-Flow Nasal Oxygen vs. Standard Facemask Oxygenation for pre- and apneic oxygenation during Anesthesia Induction: A Systematic Review and Meta-analysis

Song

Sun

Shi

et al. 2021

Preprint

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“…There may be benefit in extending the HFNO preoxygenation duration to 4 minutes, alongside applying a simple facemask to minimise air entrainment which allowed 80% of pregnant women to reach ETO 2 ≥90% (6). Whilst not significant, Al-Sulttan et al found a trend towards HFNO being more effective when used with mouth closed rather than open (16).…”

Section: High Flow Nasal Oxygenmentioning

confidence: 92%

“…Overall these studies have found that when using HFNO preoxygenation pregnant women do not reliably achieve an ETO 2 ≥90% despite up to 8 minutes preoxygenation. In the three randomised controlled trials (RCTs), facemask preoxygenation achieved a higher ETO 2 than HFNO (6,9,16). After three minutes of HFNO preoxygenation Tan & Shippam et al found that 60% and 47% patients respectively reached an ETO 2 ≥90%, with a median ETO 2 of 89% and range 70-95% (9,14).…”

Section: High Flow Nasal Oxygenmentioning

confidence: 99%

Preoxygenation in pregnant women—is it time to update the 2015 OAA/DAS guidance in light of the expanding evidence base for high flow nasal oxygen?

Preston¹

2023

Ann Palliat Med

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“…In preparation for rapid sequence induction and intubation, there may be inadequate time for pre-oxygenation to reach the desired end-tidal oxygen fraction. Although studies on the use of high-flow nasal oxygen in the obstetric population have not demonstrated significant benefits over traditional facemask for pre-oxygenation (see Table 1) [8][9][10][11][12], there is likely to be a benefit during the apnoeic phase, which is logistically more difficult to study. A clinical surrogate of desaturation was explored in a study using high-fidelity computer simulated models of pregnant patients [13].…”

Section: Preparation For Safe General Anaesthesiamentioning

confidence: 99%

Emergencies in obstetric anaesthesia: a narrative review

2022

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We conducted a narrative review in six areas of obstetric emergencies: category-1 caesarean section; difficult and failed airway; massive obstetric haemorrhage; hypertensive crisis; emergencies related to neuraxial anaesthesia; and maternal cardiac arrest. These areas represent significant research published within the last five years, with emphasis on large multicentre randomised trials, national or international practice guidelines and recommendations from major professional societies. Key topics discussed: prevention and management of failed neuraxial technique; role of high-flow nasal oxygenation and choice of neuromuscular drug in obstetric patients; prevention of accidental awareness during general anaesthesia; management of the difficult and failed obstetric airway; current perspectives on the use of tranexamic acid, fibrinogen concentrate and cell salvage; guidance on neuraxial placement in a thrombocytopenic obstetric patient; management of neuraxial drug errors, local anaesthetic systemic toxicity and unusually prolonged neuraxial block regression; and extracorporeal membrane oxygenation use in maternal cardiac arrest.

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A prospective, up-down sequential allocation study investigating the effectiveness of vital capacity breaths using high-flow nasal oxygenation versus a tight-fitting face mask to pre-oxygenate term pregnant women

Cited by 19 publications

References 32 publications

Comparison of the Effectiveness of High-Flow Nasal Oxygen vs. Standard Facemask Oxygenation for pre- and apneic oxygenation during Anesthesia Induction: A Systematic Review and Meta-analysis

Comparison of the Effectiveness of High-Flow Nasal Oxygen vs. Standard Facemask Oxygenation for pre- and apneic oxygenation during Anesthesia Induction: A Systematic Review and Meta-analysis

Preoxygenation in pregnant women—is it time to update the 2015 OAA/DAS guidance in light of the expanding evidence base for high flow nasal oxygen?

Emergencies in obstetric anaesthesia: a narrative review

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