Apneic Oxygenation May Not Prevent Severe Hypoxemia During Rapid Sequence Intubation: A Retrospective Helicopter Emergency Medical Service Study

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

“…There were four prospective cohort studies, 14,15,25,26 four RCTs, 16,17,27,28 and two retrospective cohort studies. 29,30 Table 1 summarizes the characteristics of each included study. The patient populations in the included studies were diverse, with three studies examining intubation in the ED, 15,25,28 two studies describing out-of-hospital intubation, 29,30 four studies investigating intubation in the ICU, 14,16,17,28 and one in a mixed ICU and ED population.…”

A Practical Approach to Apneic Oxygenation during Endotracheal Intubation

“…Insufflation of O 2 via nasal prongs appears to be one of the more popular routes; however, several studies have disputed its efficacy. Riyapan and Lubin [10] conducted a study on AO during prehospital rapid sequence intubation (RSI). Utilizing nasal prongs, O 2 was insufflated at 15 L/min vs. no O 2 in the control group.…”

“…Upon evaluation of the demographic data, there are several possible explanations for these results. First, among the patients in the two groups, there was a high rate of severe hypoxemia (SpO 2 < 90%) prior to airway management (14% in the AO group vs. 17% in the control group) [10]. Severe hypoxemia is reported as an independent risk factor for severe desaturation during endotracheal intubation of critically ill patients [11].…”

“…In the control group 50% of patients were preoxygenated with a bag valve mask and 46% preoxygenated via nonrebreathing mask, as compared to 24% and 65% in the AO group, respectively. Furthermore, the protocol used lacked a SpO 2 end point for preoxygenation, thus there was no way to evaluate the efficacy of preoxygenation [10]. The principle of AO relies heavily on adequate denitrogenation of the FRC, as this allows for greater entrainment of O 2 from the pharynx to the lungs [3,5].…”

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.…”