Intubation using apnoeic oxygenation to prevent desaturation: A systematic review and meta-analysis

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

“…The results from this review are in keeping with results found with other systematic reviews suggesting that AO via nasal cannulae may reduce the overall incidence of oxygen desaturation. [43][44][45][46][47] When examining the effects of AO on severe oxygen desaturation there are conflicting results. [43][44][45][46][47] Some reviews suggest that AO resulted in a decreased incidence of severe oxygen desaturation, [43][44][45] while others have concluded that there was no difference in AO compared with no AO.…”

“…[43][44][45][46][47] When examining the effects of AO on severe oxygen desaturation there are conflicting results. [43][44][45][46][47] Some reviews suggest that AO resulted in a decreased incidence of severe oxygen desaturation, [43][44][45] while others have concluded that there was no difference in AO compared with no AO. 46,47 The inconsistent results, as well as the significant clinical heterogeneity of the published studies, suggest that more well-designed clinical trials are required before standard implementation of AO during an emergency intubation should be recommended.…”

Apneic Oxygenation for Pediatric Endotracheal Intubation: A Narrative Review

“…Interestingly, a recent meta-analysis demonstrated that in adult patients intubated for respiratory failure, ApOx's benefit might be limited to decreasing the extent of desaturation, rather than preventing its occurrence. 18 An alternative mechanism may be that patients with respiratory failure are more likely to have spent time on high-flow nasal cannulas or NIV prior to intubation, leading to an oropharynx that is already filled with oxygen to large a degree. This may in turn mask some of the benefit of ApOx in the intervention groups in the studies.…”

Maintenance of Oxygenation During Rapid Sequence Intubation in the Emergency Department

“…Recently, apneic oxygenation has been promoted as an adjunct to RSI to help reduce the risk of desaturation . While the principle and technique of apneic oxygenation have been known for over half a century, the past few years have seen a great deal of research, interest, and discussion regarding its role during RSI in the critically ill . During apnea, the ongoing uptake of oxygen from the alveoli into the bloodstream creates a negative pressure gradient between the upper airway and the lungs.…”

“…Several meta‐analyses of apneic oxygenation studies have been published in the past year and all have demonstrated a clinical benefit with the use of apneic oxygenation during emergent RSI . Holyoak and colleagues performed a meta‐analysis of 17 studies involving 2,422 patients in the ED, ICU, or prehospital setting and found that there was a significant reduction in both the prevalence of mild desaturation to <90% (relative risk [RR] = 0.65) and critical desaturation to <80% (RR = 0.61). When broken down by indication for intubation, the effect became nonsignificant for patients intubated for respiratory failure, but remained significant for patients intubated for other indications.…”