Apnoeic oxygenation during intubation in the intensive care unit: A systematic review and meta-analysis

Binks, Matthew; Holyoak, Rhys; Melhuish, Thomas; Vlok, Ruan; Hodge, Anthony; Ryan, Thomas J.; White, Leigh

doi:10.1016/j.hrtlng.2017.08.001

Cited by 29 publications

(13 citation statements)

References 28 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

Tan

Loubani

Kureshi

et al. 2018

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Tan

Loubani

Kureshi

et al. 2018

Can J Anesth/J Can Anesth

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“…The use of apneic oxygenation has been explored in the adult EDs and ICUs . Napolitano et al recently published a single‐center experience to implement apneic oxygenation as a quality improvement interventions in a single pediatric ICU .…”

Section: Airway Management In the Pediatric Icu Emergency Departmentmentioning

confidence: 99%

Normal and difficult airways in children: “What’s New”—Current evidence

Fiadjoe

Nishisaki

2020

Pediatric Anesthesia

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Background Pediatric difficult airway is one of the most challenging clinical situations. We will review new concepts and evidence in pediatric normal and difficult airway management in the operating room, intensive care unit, Emergency Department, and neonatal intensive care unit. Methods Expert review of the recent literature. Results Cognitive factors, teamwork, and communication play a major role in managing pediatric difficult airway. Earlier studies evaluated videolaryngoscopes in a monolithic way yielding inconclusive results regarding their effectiveness. There are, however, substantial differences among videolaryngoscopes particularly angulated vs. nonangulated blades which have different learning and use characteristics. Each airway device has strengths and weaknesses, and combining these devices to leverage both strengths will likely yield success. In the pediatric intensive care unit, emergency department and neonatal intensive care units, adverse tracheal intubation–associated events and hypoxemia are commonly reported. Specific patient, clinician, and practice factors are associated with these occurrences. In both the operating room and other clinical areas, use of passive oxygenation will provide additional laryngoscopy time. The use of neuromuscular blockade was thought to be contraindicated in difficult airway patients. Newer evidence from observational studies showed that controlled ventilation with or without neuromuscular blockade is associated with fewer adverse events in the operating room. Similarly, a multicenter neonatal intensive care unit study showed fewer adverse events in infants who received neuromuscular blockade. Neuromuscular blockade should be avoided in patients with mucopolysaccharidosis, head and neck radiation, airway masses, and external airway compression for anticipated worsening airway collapse with neuromuscular blocker administration. Conclusion Clinicians caring for children with difficult airways should consider new cognitive paradigms and concepts, leverage the strengths of multiple devices, and consider the role of alternate anesthetic approaches such as controlled ventilation and use of neuromuscular blocking drugs in select situations. Anesthesiologists can partner with intensive care and emergency department and neonatology clinicians to improve the safety of airway management in all clinical settings.

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“…Provision of apneic oxygenation has been shown to decrease the incidence of hypoxemia and increase the incidence of first pass success of endotracheal intubation in adult emergency department (ED) and in ICU patients. 7,8 Given infants' and children's high oxygen consumption and low functional residual capacity relative to adults, 9 ApOx has a theoretical benefit of prolonging safe apnea time during intubation.…”

mentioning

confidence: 99%