Delayed Sequence Intubation: A Prospective Observational Study

Predictors of arterial desaturation during intubation: a nested case-control study of airway management—part I

“…However, patients experiencing arterial desaturation had higher mortality as compared to controls. Not surprising, hypoxemia results in added stress to an already stressed system, which could result in unwanted consequences as illustrated in the literature (35)(36)(37). In addition, it's been shown that proning patients decreases mortality and the major physiologic impact is an increase in their arterial oxygen.…”

Therapeutic Approach to the Critically Poisoned Patient

“…Delayed sequence intubation (DSI) temporarily separates the administration of the induction agent from the muscle relaxant in order to allow adequate preintubation preparation and preoxygenation [16,17]. In DSI, patients are sedated with ketamine which causes dissociation and sedation while allowing for adequate preoxygenation before the administration of a muscle relaxant.…”

“…This strategy is particularly useful in the delirious or agitated patient that cannot otherwise be preoxygenated. In one observational study, patients were induced with ketamine (starting dose of 1 mg/kg titrated to adequate sedation) and then preoxygenated for 3 min with either a non-rebreather or positive pressure ventilation (NIPPV) prior to the administration of a muscle relaxant [16]. Saturations increased from 89.9 % prior to DSI to 98.8 % afterward with an average increase of 8.9 % (95 % CI 6.4-10.9 %).…”

Intubation of the Neurologically Injured Patient

“…Weingart et al describe a method called ''delayed sequence intubation,'' which is essentially procedural sedation for the purpose of preoxygenation (21). Patients are given a dissociative dose of ketamine (1-2 mg/kg intravenous [i.v.]…”