Preoxygenation Reduces Desaturation Events and Improves Intubation Success

Davis, Daniel P.; Lemieux, Justin; Serra, John; Koenig, William; Aguilar, Steve A.

doi:10.1016/j.amj.2014.12.007

Cited by 28 publications

(14 citation statements)

References 14 publications

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“…In pre-hospital intubated trauma patients who would not have required TI, almost all outcome parameters were significantly worse when compared to spontaneously breathing controls [27]. Second, strict adherence to a pre-oxygenation protocol and difficult airway algorithm will further increase overall airway management success and patients outcome [28, 29]. Third, competence in BMV is crucial and finally enables survival in scenarios were an airway cannot be established [30, 31].…”

Section: Discussionmentioning

confidence: 99%

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

Trimmel

Beywinkler

Hornung

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundPre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer’s qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program.MethodsIn this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems.ResultsFrom 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5–42.5) vs. 19.0 (15.0–27.0) during initial training; 62.0 (41.8–86.5) vs. 33.5 (18.0–54.5) during the first, and 64.0 (34.5–93.8) vs. 27 (12.5–56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0–14.8) TIs vs. 0.0 (0.0–0.0) SGA cases during the first, and 9.0 (7.0–13.8) TIs vs. 0.0 (0.0–0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%.DiscussionNumber of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to minimize failure rates. Thus, a fixed amount of working days in anesthesia seems crucial to maintain proficiency.ConclusionsIn-hospital training programs are mandatory for non-anesthetist EMS physicians to gain competence in airway management and emergency anesthesia.Our results might be helpful when discussing the need for regulation and financing with the authorities.

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Section: Discussionmentioning

confidence: 99%

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

Trimmel

Beywinkler

Hornung

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…The practice of using modified or controlled RSI and providing facemask ventilation through the apnoeic phase is common, and modified RSI using gentle face‐mask ventilation during the apnoeic period is now standard operating procedure for the Queensland Ambulance Service . Additionally, the incidence of desaturation events in an Air Medical Service in California was markedly reduced by a protocol that included bag valve mask ventilation through the apneoic phase without any increase in self‐reported aspiration events . A Canadian literature review on rapid sequence induction concluded there was no evidence that traditional rapid sequence induction reduced the incidence of pulmonary aspiration and also that routine avoidance of bag‐valve mask ventilation was not recommended .…”

Section: Discussionmentioning

confidence: 99%

Ventilator‐assisted preoxygenation: Protocol for combining non‐invasive ventilation and apnoeic oxygenation using a portable ventilator

Grant

Khan

Keijzers

et al. 2016

Emerg Medicine Australasia

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“…Preoxygenation prior to tracheal intubation increases the volume of stored oxygen and prolongs the time interval prior to oxygen desaturation [1][2][3] . Previous studies have demonstrated the importance of preoxygenation in maintaining oxygenation of vital organs during the intubation process [4,5] . The duration of apnea is influenced by atelectasis, as well as the volume of oxygen in the Functional Residual Capacity (FRC) of the lung [6] .…”

Section: Introductionmentioning

confidence: 99%

“…The duration of apnea is influenced by atelectasis, as well as the volume of oxygen in the Functional Residual Capacity (FRC) of the lung [6] . Other contributing factors include obesity, metabolic rate, blood hemoglobin concentration and supine position [5] .…”

Section: Introductionmentioning

confidence: 99%

Effect of Obesity on the Time Required Achieving a FEO2 of 90% during Preoxygenation

White¹

2015

JDO

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An end-expiratory oxygen (FEO 2) concentration > 90% is desirable prior to tracheal intubation. We hypothesized that the time required for pre oxygenation to achieve an FEO 2 of 90% was related to patient Body Mass Index (BMI). Seventy-seven consenting patients undergoing a rapid sequence induction were enrolled. After the anesthesia rebreathing circuit was filled with 100% oxygen for 4 min, these unpremedicated patients were instructed to breathe normally following application of a tight-fitting face mask with oxygen flowing at 10 L min-1. End-tidal oxygen and carbon dioxide values were recorded during the pre oxygenation period. Induction of anesthesia was performed when the FEO 2 reached 90% or after 5 min of pre oxygenation in a standardized fashion. The times to achieve an FEO 2 of 90% were 152 ± 57, 136 ± 62 and 136 ± 70 sec in the normal, overweight and obese subgroups, respectively. A total of 7 patients failed to achieve an FEO 2 90% after 5 min of preoxygenation. Four patients also experienced a decrease in SpO 2 < 95% during the apneic period prior to tracheal intubation (3 in the obese group and 1 in the overweight group). The mean BMI (± SD) of the patients who failed to achieve a FEO 2 of 90% was 40 ± 9 kg/ m 2. The time required to achieve an FEO 2 of 90% during preoxygenation period was unrelated to the patient's BMI. However, morbidly obese patients were more likely to experience a fall in their SpO 2 to < 95% during the induction period.

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Preoxygenation Reduces Desaturation Events and Improves Intubation Success

Cited by 28 publications

References 14 publications

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

Ventilator‐assisted preoxygenation: Protocol for combining non‐invasive ventilation and apnoeic oxygenation using a portable ventilator

Effect of Obesity on the Time Required Achieving a FEO2 of 90% during Preoxygenation

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