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Review
. 2018 Mar;19(2):403-411.
doi: 10.5811/westjem.2017.12.34699. Epub 2018 Feb 22.

Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review

Joshua M Gleason  1 , Bill R Christian  1 , Erik D Barton  2
Affiliations
Review

Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review

Joshua M Gleason et al. West J Emerg Med. 2018 Mar.

Abstract

Patients requiring emergency airway management may be at greater risk of acute hypoxemic events because of underlying lung pathology, high metabolic demands, insufficient respiratory drive, obesity, or the inability to protect their airway against aspiration. Emergency tracheal intubation is often required before complete information needed to assess the risk of procedural hypoxia is acquired (i.e., arterial blood gas level, hemoglobin value, or chest radiograph). During pre-oxygenation, administering high-flow nasal oxygen in addition to a non-rebreather face mask can significantly boost the effective inspired oxygen. Similarly, with the apnea created by rapid sequence intubation (RSI) procedures, the same high-flow nasal cannula can help maintain or increase oxygen saturation during efforts to secure the tube (oral intubation). Thus, the use of nasal oxygen during pre-oxygenation and continued during apnea can prevent hypoxia before and during intubation, extending safe apnea time, and improve first-pass success attempts. We conducted a literature review of nasal-cannula apneic oxygenation during intubation, focusing on two components: oxygen saturation during intubation, and oxygen desaturation time. We performed an electronic literature search from 1980 to November 2017, using PubMed, Elsevier, ScienceDirect, and EBSCO. We identified 14 studies that pointed toward the benefits of using nasal cannula during emergency intubation.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Rate of rise of carbon dioxide (CO2) levels during intubation under different apnea conditions undertaken within the study referred to (a) airway obstruction; (b) classical apneic oxygenation; (c) low-flow intra-tracheal cannula; and (d) high-flow intratracheal cannula.
Figure 2
Figure 2
Positive pressure ventilation and peripheral oxygen saturation (SpO2) %. Patients were recorded on their initial SpO2% and lowest SpO2% during intubation. Each patient’s oxygen saturation level was raised before intubation to the respective blue lines before undergoing intubation with nasal cannula use. Red lines represent lowest SpO2 levels reached during intubation with nasal cannula usage. Vourc’h et al., 2015 reported a mean pre-oxygenation and median apneic oxygenation SpO2%, respectively.
Figure 3
Figure 3
Time to desaturation during intubation. The control (without nasal cannula or blue line) and intervention group (w/ nasal cannula or red line) both underwent preoxygenation to peripheral oxygen saturation (SpO2) ranges of 92–100% and was timed in minutes when SpO2 level fell below various thresholds (range = 92–95%). Teller et al., 1988, Taha et al., 2006, and Baraka et al., 2007 had a maximum apneic cut-off limit of 10, 6, and 4 minutes.
Figure 4
Figure 4
Hemoglobin desaturation time (initial FaO2 = 0.87). Adapted from Patel and Nouraei (2015). %SpO2 vs. time of apnea for various types of patients. FaO2, alveolar oxygenation fraction; SpO2, oxygen saturation
See this image and copyright information in PMC

References

    1. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165–75. - PubMed
    1. Levitan RM. [Accessed on July 24, 2015]. Available at: NO DESATfile://localhost/! http/::epmonthly.com:article:no-desat.
    1. Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med. 2013;44(5):992–3. - PubMed
    1. Farkas J. High-flow nasal cannula for apneic oxyventilation. [Accessed on July 24, 2015]. Available at: http://emcrit.org/pulmcrit/high-flow-nasal-cannula-for-apneic-oxyventila...
    1. Patel A, Nouraei SA. Transnasal humidified rapid-insufflation ventilatory exchange (thrive): a physiological method of increasing apnea time in patients with difficult airways. Anaesthesia. 2015;70(3):323–9. - PMC - PubMed