Flush Rate Oxygen for Emergency Airway Preoxygenation

Driver, Brian E.; Prekker, Matthew E.; Kornas, Rebecca L.; Cales, Ellen K.; Reardon, Robert F.

doi:10.1016/j.annemergmed.2016.06.018

Cited by 39 publications

(17 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have investigated the optimal strategy for preoxygenation, but so far these have only been completed on healthy volunteers or stable patients in the OR. [16][17][18][19][20][21][22][23] Given clinicians used the BVM in nearly 90% of patients in the study group our results suggest that utilizing a BVM allows a good mask seal and real-time feedback with ETO 2 monitoring, which may therefore lead to better preoxygenation.…”

Section: Discussionmentioning

confidence: 99%

Emergency physician use of end‐tidal oxygen monitoring for rapidsequence intubation

et al. 2020

View full text Add to dashboard Cite

Background End‐tidal oxygen (ETO 2 ) monitoring is used by anesthesiologists to quantify the efficacy of preoxygenation before intubation but is generally not used in emergency departments (EDs). We have previously published our findings describing preoxygenation practices in the ED during blinded use of ETO 2 . The purpose of this investigation is to determine whether the unblinded use of ETO 2 monitoring led to improvements in preoxygenation during rapid sequence intubation in the ED and also the oxygen device or technique changes that were used to achieve higher ETO 2 levels. Methods We conducted an interventional study at 2 academic EDs in Sydney, Australia and New York City, New York using ETO 2 monitoring to investigate the preoxygenation process and effectiveness. We used data collected during a previous descriptive study for the control group, in which care teams in the same 2 EDs were blinded to the ETO 2 value. In the study group, clinicians could utilize ETO 2 to improve preoxygenation. Following an education process, clinicians were able to choose the method of preoxygenation and the techniques required to attempt to achieve an ETO 2 level >85%. The primary outcome was the difference in ETO 2 levels at the time of induction between the control and study group and the secondary outcome included the methods that were attempted to improve preoxygenation. Results A convenience sample of 100 patients was enrolled in each group. The median ETO 2 level achieved at the time of induction was 80% (interquartile range 61 to 86, overall range 73) in the control group and 90% in the study group (interquartile range 83 to 92, overall range 41); the median difference was 12 (95% confidence interval: 8, 16, P = < 0.001). The majority of oxygen device changes were from non‐rebreather mask to bag‐valve‐mask (BVM) (15%, n = 15) and changes in technique from improvements in mask seal (54%, n = 34). The final device used in the study group was BVM in 87% of cases. Conclusions In 2 clinical studies of ETO 2 in academic EDs, we have demonstrated that the use of ETO 2 is feasible and associated with specific and potentially improved approaches to preoxygenation. A clinical trial is needed to further study the impact of ETO 2 on the preoxygenation process and the rate of hypoxemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Emergency physician use of end‐tidal oxygen monitoring for rapidsequence intubation

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The widespread use of non‐rebreather masks and nasal prongs at flow rates of ≤15 L/min for pre‐oxygenation is likely to represent the adoption of adult practices translated to the paediatric population. Data to support these techniques in the paediatric populations is limited, with recent adult studies suggesting that these techniques may not achieve optimal pre‐oxygenation 12–14 …”

Section: Discussionmentioning

confidence: 99%

Intubation practices for children in emergency departments and intensive care units across Australia and New Zealand: A survey of medical staff

George

Long

Gelbart

et al. 2020

Emerg Medicine Australasia

View full text Add to dashboard Cite

Objective: Intubation of children in the emergency setting is a high-risk, low incidence event. Standardisation of clinical practice has been hampered by a lack of high-quality evidence to support one technique over another. The aim of the present study is to determine clinician preference in intubation practice of children in EDs and ICUs in Australia and New Zealand to provide baseline information to allow future targeted research focused on improving the safety and efficacy of paediatric emergency airway management. Methods: The present study was a voluntary questionnaire undertaken by medical staff at registrar level or above in EDs and ICUs associated

show abstract

“…Previous work has demonstrated that patients with reduced FRC to body weight ratios have limited tolerance to apneic oxygenation . Additionally, one‐third of the patients in the apneic oxygenation group were preoxygenated with a nonrebreather (NRB) mask at 15 L/min, a technique that has been shown to result in poor preoxygenation . Inadequate preoxygenation likely would have reduced the benefit of apneic oxygenation …”

mentioning

confidence: 99%

“…This is because many NRB masks are rigid and nonconforming to the face and thus permit the entrainment of room air, which significantly reduces the FiO 2 . Interestingly, a recent study by Driver and colleagues demonstrated that the leak from a NRB mask can be compensated for by increasing the oxygen flow to the “flush rate” (flowmeter fully open). In this study, using a NRB mask with an oxygen flow of 50 L/min resulted in a mean FeO 2 of 86% in healthy adults, which was significantly higher than the mean FeO 2 achieved with a NRB mask at 15 L/min (54%) and which was comparable to the mean FeO 2 that was achieved with a BVM at 15 L/min (77%).…”

mentioning

confidence: 99%

Maintenance of Oxygenation During Rapid Sequence Intubation in the Emergency Department

Sakles

2017

Academic Emergency Medicine

View full text Add to dashboard Cite

Flush Rate Oxygen for Emergency Airway Preoxygenation

Cited by 39 publications

References 11 publications

Emergency physician use of end‐tidal oxygen monitoring for rapidsequence intubation

Emergency physician use of end‐tidal oxygen monitoring for rapidsequence intubation

Intubation practices for children in emergency departments and intensive care units across Australia and New Zealand: A survey of medical staff

Maintenance of Oxygenation During Rapid Sequence Intubation in the Emergency Department

Contact Info

Product

Resources

About