Abstract
Background
In patients requiring emergency rapid sequence intubation (RSI), 100% oxygen is often
delivered for preoxygenation to replace alveolar nitrogen with oxygen. Sometimes,
however, preoxygenation devices are prematurely removed from the patient prior to
the onset of apnea, which can lead to rapid loss of preoxygenation.
Objective
We sought to determine the elapsed time, on average, between removing the oxygen source
and the loss of preoxygenation among non–critically ill patients in the emergency
department (ED).
Methods
We conducted a prospective, crossover study of non–critically ill patients in the
ED. Each patient received two identical preoxygenation trials for 4 min using a non–rebreather
mask with oxygen flow at flush rate and a nasal cannula with oxygen flow at 10 L/min.
After each preoxygenation trial, patients underwent two trials in random order while
continuing spontaneous breathing: 1) removal of both oxygen sources and 2) removal
of non–rebreather mask with nasal cannula left in place. We defined loss of preoxygenation
as an end-tidal oxygen (exhaled oxygen percentage; EtO2) value < 70%. We measured EtO2 breath by breath until loss of preoxygenation occurred.
Results
We enrolled 42 patients, median age was 43 years (interquartile range [IQR] 30 to
54 years) and 72% were male. Median time to loss of preoxygenation was 20 s (IQR 17–25 s,
4.5 breaths) when all oxygen devices were removed, and 39 s (IQR 21–56 s, 8 breaths)
when the nasal cannula was left in place.
Conclusions
In this population of non–critically ill ED patients, most had loss of preoxygenation
after 5 breaths if all oxygen devices were removed, and after 8 breaths if a nasal
cannula was left in place. These data suggest that during ED RSI, preoxygenation devices
should be left in place until the patient is completely apneic.
Keywords
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Article info
Publication history
Published online: August 05, 2020
Accepted:
June 20,
2020
Received in revised form:
June 4,
2020
Received:
May 4,
2020
Footnotes
This article was accepted for presentation at the Annual Meeting for the Society of Academic Emergency Medicine, Denver, CO, May 2020.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
