Preoxygenation and Prevention of Desaturation During Emergency Airway Management - Scott Weingart, Richard Levitan.

The March 2012 edition of the Annals of Emergency medicine, is this master piece from emergency airway gurus Scott Weingart and Richard Levitan. They discuss and review pre-oxygenation and peri-intubation oxygenation techniques to minimize the risk of hypoxia.

Pearls from the article include:

• Pre-oxygenation extends the duration of safe apnoea in emergency tracheal intubation
• Standard reservoir face masks with high flow oxygen is the recommened source of high FiO2 for pre-oxygenation.
• Patients with normal respiratory drive should be pre-oxygenated for 3 minutes or take 8 maximal inhalation/exhalation breaths
• NIV (non-invasive ventilation) should be considered for pre-oxygenation and ventilation during the onset phase of muscle relaxation in patients who cannot achieve saturations greater than 93-95 % with high FiO2
• Patients should be positioned in the head up position whenever possible. In patients with spinal precautions, reverse trendelenburg can be used
• Apnoeic oxygenation can extend the duration of safe apnoea when used with sedation and muscle relaxants. A nasal cannula set at 15L/min is an effective means of providing this during ED intubations.
• For intubation, patients should be positioned to maximize upper airway patency before and during the apnoeic period, using ear to sternal positioning. Nasal airways and jaw thrust may help to create a patent airway.
• In patients at high risk of desaturation, rocuronium may provide a longer duration of safe apnoea than succinylcholine. 

Pre-oxygenation and Prevention of Desaturation During Emergency Airway Management

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