The impact of a rapid sequence intubation on arterial blood gases during the preoxygenation phase performed in a Hospital emergency department

Abstract

Aim: During rapid sequence intubation (RSI), the O 2 reserve limits the intubation duration. The study objective was to examine the impact of RSI on arterial blood gases (ABG) during the preoxygenation phase.Methods: This open, prospective clinical study examined samples of patients who had endotracheal intubation (ETI) as RSI between March 2014 and September 2014 in our emergency department. The variations in ABG PaO 2 and PaCO 2 before and after preoxygenation and after intubation were examined and compared with demographic and clinical variables.Results: The study included 67 patients (46 male, 21 female) with a mean age of 69.9 years. SBP, DBP, and MABP decreased, while pulse rate and SpO 2 increased. No difference was observed between PaO 2 values and demographic and clinical variables; however, a statistically significant relationship was found between the difference (Δ) between PaO 2 values measured after endotracheal tracheal intubation (ETI) and after preoxygenation and the ABG SpO 2 and the SpO 2 classification before preoxygenation. Conclusion:The relationship between SpO 2 and its classification following ETI and increased ABG SpO 2 was statistically significant. Our real-life study emphasises that deciding on intubation without desaturating patients could have positive effects on intubation success. Regardless, increasing SpO 2 prior to ETI will contribute positively to the O 2 reserve by the end of ETI.The ΔPaO 2 , before and after preoxygenation, was not affected by age; gender; body mass index (BMI) and its classification; GCSS; vital signs and ABG find-ings gathered before preoxygenation; respiration rate (RR) during preoxygenation; preoxygenation duration; oral air passage usage or air leakage.

“Zooming” in strategies and outcomes for trauma cases with Injury Severity Score (ISS) ≥16: promise or passé?

“…Severe trauma results in a strong inflammatory response and life-threatening complications. VAP in the ICU can be expected in critically injured cases who are on mechanical ventilation (MV) 19 , for more than 2 days, with an incidence ranging from 5% to 40% and a mortality rate of 10% 20 . The complex pathophysiology of MODS after trauma includes multifactorial pathologies such as initial exsanguination, MBT, and systemic inflammatory response, of which the most crucial is the severity of injury 21 .…”