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Apneic Oxygenation via Nasal Prongs at 10 L/min Prevents Hypoxemia During Elective Tracheal Intubation FREE TO VIEW

Chris Christodoulou, MD; Tim Mullen, MD; Tony Tran, MD; Pam Rohald, MD; Brett Hiebert, MMSc; Sat Sharma, MD
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University of Manitoba, Winnipeg, MB, Canada

Chest. 2013;144(4_MeetingAbstracts):890A. doi:10.1378/chest.1705225
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SESSION TITLE: Ventilatory Strategies in Severe Hypoxemia

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM

PURPOSE: Hypoxemia during airway management remains an important cause of morbidity and mortality. Oxygenation during intubation via nasal prongs may prevent critical desaturations (Anesthesiology 1988, J Korean Med Sci 1998). We evaluated the effectiveness of oxygen administration via nasal prongs during apneic period following induction of general anesthesia.

METHODS: We conducted a randomized, controlled, double-blind study in patients without significant cardiac or respiratory disease undergoing elective surgery (age 18-65, ASA I-III). Patients randomly received oxygen via nasal prongs at 0, 5, or 10 L/min. Following preoxygenation, general anesthesia was induced. At 90 seconds after induction, nasal prongs were applied and oxygen was delivered according to the experimental group. At 4.5 minutes post-induction the patients were intubated.

RESULTS: The final study population consisted of 41 individuals, with 14 in the 0 L group, 13 in the 5 L group, and 14 in the 10 L group. The mean values are 134 ± 75, 168 ± 138 and 253 ± 146 mmHg respectively. A statistically significant difference was demonstrated between the three treatment protocols (p=0.030), across time (p=0.028), and in the treatment effect across time (p=0.017). Mean PaO2 was higher in the 10 L group (p=0.001) than the 5 L group and 0 L group at 4.5 minutes (p=0.004).

CONCLUSIONS: Apneic oxygenation with 10 L/min compared to 5 Lmin via nasal prongs demonstrated delay of desaturation and maintenance of higher PaO2 levels during elective intubation.

CLINICAL IMPLICATIONS: Nasal prongs are available in all of the patient care areas; therefore this simple, benign, inexpensive technique may be useful as a routine addition to airway management.

DISCLOSURE: The following authors have nothing to disclose: Chris Christodoulou, Tim Mullen, Tony Tran, Pam Rohald, Brett Hiebert, Sat Sharma

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