Apneic Oxygenation via Nasal Prongs at 10 L/min Prevents Hypoxemia During Elective Tracheal Intubation

Christodoulou, Chris; Mullen, Tim; Tran, Tony; Rohald, Pam; Hiebert, Brett; Sharma, Sat

doi:10.1378/chest.1705225

Cited by 8 publications

(4 citation statements)

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“…Christodoulou et al 16 examined the difference amongst patients randomized during tracheal intubation into three groups: apneic oxygenation via nasal prongs at a rate of 5 LÁmin -1 (n = 13), 10 LÁmin -1 (n = 14), or no apneic oxygenation control group (n = 14). Apneic oxygenation provided a significant difference in time to desaturation (P = 0.028) compared with the control group.…”

Section: Apneic Oxygenation For Tracheal Intubation In Various Clinicmentioning

confidence: 99%

The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review

Wong

Yee

Leong

et al. 2017

Can J Anesth/J Can Anesth

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Sixteen of the 19 studies showed that apneic oxygenation prolongs safe apneic time and reduces the incidence of arterial oxygen desaturation. Overall, studies in this review show that apneic oxygenation prolongs the time to oxygen desaturation during tracheal intubation. Nevertheless, the majority of the studies were small in size, and they neither measured nor were adequately powered to detect adverse respiratory events or other serious rare complications. Prolonged apneic oxygenation (with its consequent hypercarbia) can have risks and should be avoided in patients with conditions such as increased intracranial pressure, metabolic acidosis, hyperkalemia, and pulmonary hypertension.

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Section: Apneic Oxygenation For Tracheal Intubation In Various Clinicmentioning

confidence: 99%

The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review

Wong

Yee

Leong

et al. 2017

Can J Anesth/J Can Anesth

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show abstract

“…There was no significant difference in duration of ventilation in the intensive care unit with apnoeic oxygenation (RR -1.97, 95% CI -5.89-1.95, P=0.32) 12,15 . Apnoeic oxygenation improved PaO 2 at 3-4.5 minutes of apnoea (mean difference 84.12, 95% CI 47.22-121.02; P <0.0001) 16,17 and reduced re-saturation time (mean difference -66.55, 95% CI -95.10--38.01, P <0.05) 3,7 .…”

Section: Meta-analysismentioning

confidence: 95%

Apnoeic Oxygenation during Intubation: A Systematic Review and Meta-analysis

White

Melhuish

Wallace

2017

Anaesth Intensive Care

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Apnoeic oxygenation during intubation is used to prevent desaturation during intubation. The aim of this review was to assess whether apnoeic oxygenation during endotracheal intubation reduced the incidence of hypoxaemia. Five major databases were systematically searched for all relevant studies published up to May 2016. All study designs with a control group and a group receiving apnoeic oxygenation were included in this review. These studies were then assessed for level of evidence and risk of bias. The data were then analysed using a meta-analysis. Eleven studies (six high quality randomised controlled trials, four low quality level two studies and one low quality level three study) were found. In the meta-analysis there was strong evidence for benefit of apnoeic oxygenation in terms of improved SpO 2 in elective surgical patients, obese patients and those undergoing emergency intubation without respiratory failure. However, no significant benefit was found in patients with respiratory failure. This is the first meta-analysis to be performed on apnoeic oxygenation during intubation. Apnoeic oxygenation provides significant benefit in terms of improving SpO 2 for the majority of intubations, although there appears to be no benefit in patients whose indication for intubation is respiratory failure. Apnoeic oxygenation ought to be considered for integration into intubation protocols.

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“…Standard nasal oxygen cannulas are widely used in the healthcare setting since their introduction in the 1940s and have remained largely unchanged to the present day. Their use at lower flows, at up to 10 L/min, has been studied and has demonstrated a modest increase in time to oxygen desaturation when used at the time of induction of anesthesia [ 4 , 5 ]. The use of supplemental nasal oxygen during tracheal intubation is supported by societal guidelines [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Volunteer Crossover Feasibility Study to Compare Standard Oxygen Cannula Used at High-Flow to Proprietary High-Flow Humidified Nasal Oxygen Systems

Johnson¹,

Devine²,

Marshall³

2023

Cureus

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Background and aim: Supplemental oxygen is routinely administered to patients prior to and during induction of general anesthesia and sedation. This increases the fraction of oxygen in the lungs, increases oxygen delivery, and increases the time to oxygen desaturation. Proprietary Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) systems, which deliver warmed and humidified oxygen, have been extensively researched in the perioperative and critical care setting and have been shown to significantly prolong time to desaturation and as a means of ventilatory support. The use of traditional nasal oxygen cannula used at maximum flow rates is currently used in short bursts as it is poorly tolerated. There is however a dearth of data examining the use of this technique. We hypothesized that traditional nasal oxygen cannulae used at maximum flow rates can deliver oxygen as effectively as THRIVE in this setting.Methods: We designed a crossover volunteer feasibility study. The participants were 10 healthy anesthetists. We compared the two methods of oxygen delivery by measuring transcutaneous oxygen measurement and pharyngeal oxygen concentration. Comfort and noise levels were recorded. The aforementioned parameters were compared between the two groups.Results: We observed that a standard oxygen cannula used at high flows delivers comparable oxygen delivery and tissue oxygenation performance to proprietary THRIVE systems. However, they are less comfortable and make more noise. Discussion: To the authors' knowledge this study is the first to study the oxygen delivery of traditional nasal oxygen cannula used at maximum flow rates and make comparisons to the well-studied THRIVE technique. While similar transcutaneous partial pressure of oxygen and pharyngeal gas concentrations were observed with both techniques, the standard cannulae were deemed to be a lot less comfortable than THRIVE and made a lot more noise which likely limit the utility of this technique outside of short bursts.Conclusion: In this study, a standard nasal oxygen cannula used at high flows achieved similar oxygen delivery to THRIVE at the expense of poor comfort and increased noise.

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Apneic Oxygenation via Nasal Prongs at 10 L/min Prevents Hypoxemia During Elective Tracheal Intubation

Cited by 8 publications

References 0 publications

The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review

The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review

Apnoeic Oxygenation during Intubation: A Systematic Review and Meta-analysis

A Volunteer Crossover Feasibility Study to Compare Standard Oxygen Cannula Used at High-Flow to Proprietary High-Flow Humidified Nasal Oxygen Systems

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