Apneic oxygenation - Revision history

ClaireLewis: /* References */

2019-10-07T13:34:52Z

References

← Older revision		Revision as of 13:34, 7 October 2019
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	[[Category:Procedures]]		[[Category:Procedures]]
			[[Category:Critical Care]]

Mholtz at 08:41, 24 February 2019

2019-02-24T08:41:30Z

← Older revision		Revision as of 08:41, 24 February 2019
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	==See Also==		==See Also==
	*{{Related Difficult Airway Pages}}		{{Related Difficult Airway Pages}}

	==External Links==		==External Links==

Mholtz at 08:41, 24 February 2019

2019-02-24T08:41:05Z

← Older revision		Revision as of 08:41, 24 February 2019
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	==Overview==		==Overview==
	~~'''Apneic oxygenation''' is a technique that~~ prolongs "safe apnea time" (time until desaturation to SaO2=88-90%) after induction of apnea. This increases time for laryngoscopy/intubation.		*Technique to prolongs "safe apnea time" (time until desaturation to SaO2=88-90% after induction of apnea). This increases time for laryngoscopy/intubation.
	*an ''adjunct'' to preoxygenation: used to prolong oxygenation after optimal preoxygenation		*Used as an ''adjunct'' to preoxygenation: used to prolong oxygenation after optimal preoxygenation
	*~~low~~ cost in terms of resources and set-up		*Low cost in terms of resources and set-up

	==Physiology==		==Physiology==
	*~~gas~~ exchange during apnea creates subatmopsheric pressure in the alveoli		*Gas exchange during apnea creates subatmopsheric pressure in the alveoli
	**in healthy lungs, 200-250mL O2 per minute can be drawn into blood stream		**In healthy lungs, 200-250mL O2 per minute can be drawn into blood stream
	**in the absence of ventilation (i.e. during apnea), only 10-20mL CO2 enters alveoli from bloodstream per minute, due to increased CO2 tension		**In the absence of ventilation (i.e. during apnea), only 10-20mL CO2 enters alveoli from bloodstream per minute, due to increased CO2 tension
	**~~this~~ causes a net decrease in gas in the alveoli		**This causes a net decrease in gas in the alveoli
	*~~this~~ gradient can draw air into the lungs, even absent diaphragmatic movement		*This gradient can draw air into the lungs, even absent diaphragmatic movement
	*~~increases~~ safe apnea time in healthy volunteers from 1 minute (room air) to 8-9 minutes		*Increases safe apnea time in healthy volunteers from 1 minute (room air) to 8-9 minutes

	==Indications==		==Indications==
	*~~intubation~~		*[[Intubation]]

	==Contraindications==		==Contraindications==
	*~~severe~~ maxillofacial trauma		*Severe maxillofacial trauma
	*~~obstructed~~ nares		*Obstructed nares

	==Equipment Needed==		==Equipment Needed==
	*~~nasal~~ cannula		*Nasal cannula
	*~~second~~ oxygen source, e.g. mobile O2 tank		*Second oxygen source, e.g. mobile O2 tank

	==Procedure==		==Procedure==
	#Start pre-oxygenation while sitting upright, only lay back once [[RSI]] drugs pushed.		#Start pre-oxygenation while sitting upright, only lay back once [[RSI]] drugs pushed.
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	==Complications/Limitations==		==Complications/Limitations==
	*~~complications~~ are limited and most can be quickly remedied by removing nasal cannula		*Complications are limited and most can be quickly remedied by removing nasal cannula
	**if not well-positioned/attached, may complicate laryngoscopy		**If not well-positioned/attached, may complicate laryngoscopy
	**~~high~~ flow oxygen from nasal cannula is cold and dry; may not be well-tolerated by patient		**High flow oxygen from nasal cannula is cold and dry; may not be well-tolerated by patient
	**~~extremely~~ high flow oxygen (>70 L/M) may cause barotrauma		**Extremely high flow oxygen (>70 L/M) may cause barotrauma
	**~~increased~~ apnea time increases respiratory acidosis		**Increased apnea time increases respiratory acidosis
	*~~not~~ shown to improve saturation in critically ill patients		*Not shown to improve saturation in critically ill patients

	==See Also==		==See Also==
	{{Related Difficult Airway Pages}}		*{{Related Difficult Airway Pages}}

	==External Links==		==External Links==
	https://emcrit.org/pulmcrit/preoxygenation-apneic-oxygenation-using-a-nasal-cannula/		*https://emcrit.org/pulmcrit/preoxygenation-apneic-oxygenation-using-a-nasal-cannula/

	==References==		==References==
	<references/>		<references/>
	*Moran C, Karalapillai D, Darvall J, Nanuan A. Is it time for apnoeic oxygenation during endotracheal intubation in critically ill patients? Critical care and resuscitation. 16(3):233-5. 2014.
	*Semler MW, Janz DR, Lentz RJ. Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill. American journal of respiratory and critical care medicine. 2015.
	*Hayes-Bradley C, Lewis A, Burns B, Miller M. Efficacy of Nasal Cannula Oxygen as a Preoxygenation Adjunct in Emergency Airway Management. Annals of emergency medicine. 68(2):174-80. 2016.
	*Lynn E. Teller, M.D., Christian M. Alexander, M.D., M. Jack Frumin, M.D., Jeffrey B. Gross, M.D.; Pharyngeal Insufflation of Oxygen Prevents Arterial Desaturation during Apnea. Anesthes 1988;69(6):980-982.
	[[Category:Procedures]]		[[Category:Procedures]]

Rossdonaldson1: /* See Also */

2019-02-02T14:08:25Z

Rossdonaldson1: /* Procedure */

2019-02-01T08:04:19Z

Procedure

← Older revision		Revision as of 08:04, 1 February 2019
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	*second oxygen source, e.g. mobile O2 tank		*second oxygen source, e.g. mobile O2 tank
	==Procedure==		==Procedure==
			#Start pre-oxygenation while sitting upright, only lay back once [[RSI]] drugs pushed.
	#During preoxygenation, keep the nasal cannula on underneath your primary preoxygenation technique.		#During preoxygenation, keep the nasal cannula on underneath your primary preoxygenation technique.
	#*This can be achieved whether you use a mask, NPPV, or BVM; a good seal can still be obtained. Alternatively, you can use the [[high flow nasal cannula]] technique for preoxygenation.		#*This can be achieved whether you use a mask, NPPV, or BVM; a good seal can still be obtained. Alternatively, you can use the [[high flow nasal cannula]] technique for preoxygenation.
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	#After preoxygenation, leave the nasal cannula on after removing mask/NPPV/BVM. It should not get in the way of laryngoscopy.		#After preoxygenation, leave the nasal cannula on after removing mask/NPPV/BVM. It should not get in the way of laryngoscopy.
	#*Consider taping cannula to face to prevent dislodgement.		#*Consider taping cannula to face to prevent dislodgement.

	==Complications/Limitations==		==Complications/Limitations==
	*complications are limited and most can be quickly remedied by removing nasal cannula		*complications are limited and most can be quickly remedied by removing nasal cannula

Chungirv: Apneic Oxygenation Procedure

2017-08-01T17:34:41Z

Apneic Oxygenation Procedure

New page

==Overview==
'''Apneic oxygenation''' is a technique that prolongs "safe apnea time" (time until desaturation to SaO2=88-90%) after induction of apnea. This increases time for laryngoscopy/intubation.
*an ''adjunct'' to preoxygenation: used to prolong oxygenation after optimal preoxygenation
*low cost in terms of resources and set-up
==Physiology==
*gas exchange during apnea creates subatmopsheric pressure in the alveoli
**in healthy lungs, 200-250mL O2 per minute can be drawn into blood stream
**in the absence of ventilation (i.e. during apnea), only 10-20mL CO2 enters alveoli from bloodstream per minute, due to increased CO2 tension
**this causes a net decrease in gas in the alveoli
*this gradient can draw air into the lungs, even absent diaphragmatic movement
*increases safe apnea time in healthy volunteers from 1 minute (room air) to 8-9 minutes

==Indications==
*intubation
==Contraindications==
*severe maxillofacial trauma
*obstructed nares
==Equipment Needed==
*nasal cannula
*second oxygen source, e.g. mobile O2 tank
==Procedure==
#During preoxygenation, keep the nasal cannula on underneath your primary preoxygenation technique.
#*This can be achieved whether you use a mask, NPPV, or BVM; a good seal can still be obtained. Alternatively, you can use the [[high flow nasal cannula]] technique for preoxygenation.
#*Normal adjunctive airway techniques/equipment (jaw thrust, oropharyngeal airway) remain useful. In particular, nasal trumpet can maintain patencny of at least one nare.
#Attach the nasal cannula to a separate oxygen source at 15L.
#After preoxygenation, leave the nasal cannula on after removing mask/NPPV/BVM. It should not get in the way of laryngoscopy.
#*Consider taping cannula to face to prevent dislodgement.
==Complications/Limitations==
*complications are limited and most can be quickly remedied by removing nasal cannula
**if not well-positioned/attached, may complicate laryngoscopy
**high flow oxygen from nasal cannula is cold and dry; may not be well-tolerated by patient
**extremely high flow oxygen (>70 L/M) may cause barotrauma
**increased apnea time increases respiratory acidosis
*not shown to improve saturation in critically ill patients
==See Also==
*[[EBQ:ED Preoxygenation]]
*[[Rapid sequence intubation]]
*[[Intubation]]
==External Links==
https://emcrit.org/pulmcrit/preoxygenation-apneic-oxygenation-using-a-nasal-cannula/
==References==
<references/>
*Moran C, Karalapillai D, Darvall J, Nanuan A. Is it time for apnoeic oxygenation during endotracheal intubation in critically ill patients? Critical care and resuscitation. 16(3):233-5. 2014.
*Semler MW, Janz DR, Lentz RJ. Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill. American journal of respiratory and critical care medicine. 2015.
*Hayes-Bradley C, Lewis A, Burns B, Miller M. Efficacy of Nasal Cannula Oxygen as a Preoxygenation Adjunct in Emergency Airway Management. Annals of emergency medicine. 68(2):174-80. 2016.
*Lynn E. Teller, M.D., Christian M. Alexander, M.D., M. Jack Frumin, M.D., Jeffrey B. Gross, M.D.; Pharyngeal Insufflation of Oxygen Prevents Arterial Desaturation during Apnea. Anesthes 1988;69(6):980-982.
[[Category:Procedures]]

← Older revision		Revision as of 14:08, 2 February 2019
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	*not shown to improve saturation in critically ill patients		*not shown to improve saturation in critically ill patients
	==See Also==		==See Also==
	*[[EBQ:ED Preoxygenation]]		{{Related Difficult Airway Pages}}
	*[[Rapid sequence intubation]]
	*[[Intubation]]
	==External Links==		==External Links==
	https://emcrit.org/pulmcrit/preoxygenation-apneic-oxygenation-using-a-nasal-cannula/		https://emcrit.org/pulmcrit/preoxygenation-apneic-oxygenation-using-a-nasal-cannula/