Apneic Oxygenation Was Associated With Decreased Desaturation Rates During Rapid Sequence Intubation by an Australian Helicopter Emergency Medicine Service

Preoxygenation and apneic oxygenation using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange for emergency intubation

“…More recently, pre-oxygenation using a non-re-breather face mask followed by apnoeic oxygenation by insufflating oxygen at a flow rate of 15 L/min via nasal cannula (NO-DESAT) and the continuous delivery of transnasal highflow humidified oxygen (THRIVE) have been reported as methods to reduce desaturation in high risk intubations, with the latter having been shown to extend the safe apnoea time between 5-65 minutes [12,7]. NO-DESAT has demonstrated effectiveness in both emergency department and out of hospital settings [12,13] and THRIVE has been shown to be useful in elective surgical and critical care patients [7,8]. Whilst both NO-DESAT and THRIVE provide apnoeic oxygenation, NO-DESAT is reliant on pre-oxygenation with either a non-rebreather or anaesthetic facemask and does not provide CPAP.…”

Cardiac Arrests Associated With Tracheal Intubations in PICUs: A Multicenter Cohort Study*

“…Importantly, these data suggest interventions that may modify the likelihood of TI-associated CA. These interventions potentially include 1) providing oxygen with high-flow nasal oxygen throughout TI attempts (i.e., apneic oxygenation) to minimize hypoxemia (23,24); 2) aggressive hemodynamic support before and during TI; and 3) special planning, including interdisciplinary approach and possibly primary use of video (indirect) laryngoscopy for TI of critically ill children with difficult airway. The 1.7% incidence of pediatric TI-associated CAs in the PICU is more than 100-fold greater than the incidence of CAs among deeply anesthetized children in the operating room.…”

Intubation of the Neurologically Injured Patient

“…This technique has been extrapolated from the anesthesia literature; it improves preoxygenation and prevention of desaturation while intubating patients. Furthermore, there is recent literature showing the feasibility, safety, and decrease in desaturation of this practice during intubation in the prehospital setting and the emergency department (ED) (10)(11)(12). This is a simple method that can improve preoxygenation, and its utilization is highly recommended during any intubation.…”