Efficacy of Nasal Cannula Oxygen as a Preoxygenation Adjunct in Emergency Airway Management

Hayes‐Bradley, Clare; Lewis, Anthony; Burns, Brian; Miller, Matthew

doi:10.1016/j.annemergmed.2015.11.012

Cited by 47 publications

(26 citation statements)

References 17 publications

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“…[11] Nasal cannula oxygen supplementation can improve the efficacy of pre-oxygenation if there is a mask leak. [12] Pre-oxygenation with eight vital capacity breaths for 60 s is an alternative method that is more effective. Pre-oxygenation following forced exhalation followed by tidal breathing is also more effective.…”

Section: Optimising Endotracheal Intubationmentioning

confidence: 99%

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

et al. 2016

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The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes ‘complete ventilation failure’, and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a ‘difficult airway alert form’ must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart.

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Section: Optimising Endotracheal Intubationmentioning

confidence: 99%

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

et al. 2016

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“…Recently, the addition of supplemental oxygen through a nasal cannula in the presence of mask leaks has been shown to improve the end-tidal O 2 during preoxygenation. [30]…”

Section: Special Considerations During Tracheal Intubation In Intensimentioning

confidence: 99%

Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit

Myatra

Kundra

Garg

et al. 2017

Indian Journal of Critical Care Medicine

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Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60–70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

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“…Recently, the addition of supplemental oxygen through a nasal cannula in the presence of mask leaks has been shown to improve the end-tidal oxygen during pre-oxygenation. [30]…”

Section: Special Considerations During Tracheal Intubation In the Intmentioning

confidence: 99%

The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

et al. 2016

View full text Add to dashboard Cite

Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60–70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

show abstract

Efficacy of Nasal Cannula Oxygen as a Preoxygenation Adjunct in Emergency Airway Management

Cited by 47 publications

References 17 publications

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit

The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

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