Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis

How to use humidified high‐flow nasal cannula in breathless adults in the emergency department

“…HHFNC has been recommended for spontaneously breathing adults with hypoxemia, or discomfort from increased respiratory effort. 5,[8][9][10][11] It has been used in adults with acute respiratory failure, 12 pneumonia, 12 immunocompromise, 13 during airway procedures, 14 post-extubation 15 and palliative care. 3,16 The utility of HHFNC in hypercapnic respiratory failure is still uncertain.…”

Efficacy and Safety of Using High-Flow Nasal Oxygenation in Patients Undergoing Rapid Sequence Intubation

“…However, when an endotracheal rapid sequence intubation (RSI) for emergency surgery is needed, options for pre-and re-oxygenation are limited because of the risk of gastric insufflation leading to increased intra-gastric pressure and raised risk of pulmonary aspiration using standard bag/facemask ventilation (1)(2)(3)(4).…”

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.…”

“…Several meta‐analyses of apneic oxygenation studies have been published in the past year and all have demonstrated a clinical benefit with the use of apneic oxygenation during emergent RSI . Holyoak and colleagues performed a meta‐analysis of 17 studies involving 2,422 patients in the ED, ICU, or prehospital setting and found that there was a significant reduction in both the prevalence of mild desaturation to <90% (relative risk [RR] = 0.65) and critical desaturation to <80% (RR = 0.61).…”

“…While apneic oxygenation recently has come into vogue for emergent intubation, perhaps the issue that warrants greater consideration is the provision of proper preoxygenation in the critically ill . Increased attention to this crucial step of RSI is likely to reduce the likelihood of desaturation in the critically ill and thus have the greatest impact on patient safety .…”