Does apneic oxygenation prevent desaturation during emergency airway management? A systematic review and meta-analysis

Abstract

Nos constatations suggèrent que l'OA par lunettes nasales est associée à un moindre risque de désaturation en oxygène au cours des intubations en urgence. Cependant, compte de tenu de l'hétérogénéité des études, d'autres essais de grande qualité sont nécessaires pour déterminer quels patients pourraient bénéficier de l'OA au cours des intubations d'urgence.

In reply: Apneic oxygenation during emergency airway management

“…We thank Dr. El-Orbany for the comments regarding our paper on the use of apneic oxygenation (AO) to prevent oxygen desaturation during emergency intubations. 1 While our paper suggested a potential benefit of AO using nasal cannulae to prevent oxygen desaturation, 2 we agree that AO is not a replacement for good preoxygenation. Preoxygenation is the gold standard in preventing oxygen desaturation during intubation.…”

“…The differences in preoxygenation technique may have influenced the results of each study, but it was not possible to determine this from the evidence presented. 2 This discrepancy highlights the need for a standardized preoxygenation technique to assess the benefits of AO in emergency intubations.…”

Nasal high-flow preoxygenation for endotracheal intubation in the critically ill patient? Pro

“…Since the introduction of HFNC, one before-andafter study and three randomized controlled trials *Correspondence: jean-damien.ricard@aphp.fr; c.gregoretti@gmail.com 1 Service de Médecine Intensive-Réanimation, Hôpital Louis Mourier, AP-HP, Colombes, France 4 UOC Anestesia e Rianimazione A.O.Universitaria "P.Giaccone", Palermo, Italy Full author information is available at the end of the article compared this device to standard BVM in the context of ICU patients requiring emergent intubation with discrepant results [1]. These studies, along with others performed in the emergency department or the prehospital setting were included in a recent meta-analysis that concluded that "apneic oxygenation [was] associated with a decreased incidence of oxygen desaturation in emergency intubations" [12].…”

“…Hence, those that believe that HFNC should not be used for the preoxygenation would reach the ludicrous decision of having to remove HFNC from a patient who requires intubation and replacing it with a BVM to ensure pre-oxygenation. The results from meta-analyses tell us that this would not be appropriate [3,12].…”

Apneic oxygenation during emergency airway management

“…To the Editor, Tan et al 1 performed a systematic review and metaanalysis to evaluate the effectiveness of apneic oxygenation (AO) in preventing oxygen desaturation during emergency intubations. The authors are to be applauded for trying to get the facts out of all the available, and sometimes conflicting, literature.…”