6533b7d9fe1ef96bd126b904

RESEARCH PRODUCT

Efficacy and Safety of Using High-Flow Nasal Oxygenation in Patients Undergoing Rapid Sequence Intubation

Andrea CortegianiCesare GregorettiGiuseppe AccursoAntonino GiarratanoClaudia ProcacciantiSabrina CarusoSanti Maurizio RaineriFilippo Vitale

subject

medicine.medical_specialtyMean arterial pressuremedicine.medical_treatmentLaryngoscopyHigh-flow nasal oxygen therapy; Pre-oxygenation; Rapid sequence intubation; Emergency Medicine; Anesthesiology and Pain MedicineHigh-flow nasal oxygen therapy03 medical and health sciences0302 clinical medicine030202 anesthesiologyInterquartile rangeRapid sequence intubationmedicineIntubationGeneral anaesthesiaRocuroniummedicine.diagnostic_testbusiness.industryRapid sequence inductionSurgeryPre-oxygenationAnesthesiology and Pain Medicine030228 respiratory systemAnesthesiaEmergency MedicineOriginal ArticlePropofolbusinessmedicine.drug

description

Objective To assess the efficacy and safety of high-flow nasal oxygen (HFNO) therapy in patients undergoing rapid sequence intubation (RSI) for emergency abdominal surgery. Methods HFNO of 60 L.min-1 at an inspiratory oxygen fraction of 1 was delivered 4 min before laryngoscopy and maintained until the patient was intubated, and correct intubation was verified by the appearance of the end-tidal CO2 (EtCO2) waveform. Transcutaneous oxygenation (SpO2), heart rate and non-invasive mean arterial pressure were monitored at baseline (T0), after 4 min on HFNO (T1) and at the time of laryngoscopy (T2) and endotracheal intubation (ETI) (T3). An SpO2 of <3% from baseline was recorded at any sampled time. The value of EtCO2 at T3 was registered after two mechanical breaths. The apnoea time was defined as the time from the end of propofol injection to ETI. RSI was performed with propofol, fentanyl and rocuronium. Results Forty-five patients were enrolled. SpO2 levels showed a statistically significant increase at T1, T2 and T3 compared with those at T0 (p<0.05); median SpO2% (interquartile range) was 97% (range, 96%-99%) at T0, 99% (range, 99%-100%) at T1, 99% (range, 99%-100%) at T2 and 99% (range, 99%-100%) at T3. Minimal SpO2 was 96%; no patient showed an SpO2 of <3% from baseline; mean EtCO2 at the time of ETI was 36±4 mmHg. Maximum apnoea time was 12 min. Conclusion HFNO is an effective and safe technique for pre-oxygenation in patients undergoing rapid sequence induction of general anaesthesia for emergency surgery.

yearjournalcountryeditionlanguage
2017-01-01Turkish Journal of Anesthesia and Reanimation
https://doi.org/10.5152/tjar.2017.47048