APNEIC OXYGENATION (AO): What is it, and is it even necessary????
-
APNEIC OXYGENATION (DEFINITION TIME BOYS!): Providing 15L NC during the act of intubation (while your blade is in the dudes/dudettes mouth. Thought to decrease odds of desaturation thus preventing the need for bagging (YUK) during intubation.
-
ANESTHIOLOGISTS still bag people almost every intubation. Yet most of those people have been fasting for hours and don't have anything to throw up. We don't have that luxury.
-
HYPOXEMIA (result of desaturating during intubation) can lead to cardiopulmonary arrest. Then you're in deep doodoo. So does throwing a NC on them really help???
BUT JOSH, THIS IS STANDARD OF CARE!$#$^%*&$
WHY NOT JUST PUT ON A NC FOR INTUBATING?????? WHY ARE YOU WASTING DR. PRINCE ROCHLIN'S TIME????
Well we may not have to, and may be harming patients by delaying intubation.
There were 2 papers recently studying apneic oxygenation. (links to critical evals at end of email)
-
FELLOW TRIAL (2011) :150 patients randomized to AO or none. Since center, prospective, randomized, HOWEVER IN ICU. These patients all got PRE-OXYGENATION to 100% for 3 minutes. FOUND NO DIFFERENCE IN:
-
Lowest O2 level, incidence of desaturation, and even HOSPITAL MORTALITY (wow these people are awesome researchers!)
-
-
ENDAO TRIAL (2017): 200 patients randomized to AO or non. Single center, prospective, randomized. in the ED. Again, all pre-oxygenated. FOUND NO DIFFERENCE IN:
-
Incidence of desaturations, Mortality within 24 hours and Hospital Mortality (see sweet data that follows)
-
JOSH IT SEEMS LIKE YOUR TELLING ME THAT WE CAN JUST CUT NASAL CANNULA'S OUT OF THE BUDGET FOR INTUBATIONS, SAVE A BUTTLOAD OF MONEY FOR THE HOSPITAL, BE A HERO, AND SAVE SOME GOD DAMN LIVES!
Kind of? Both of these papers glossed over the fact that these patients were pre-oxygenated with either NRB, NC+NRB, HFNC, or BiPAP. Only NRB or BiPAP would require an extra step of putting a NC on in intubation. So if you've already got a NC on, there's no harm in leaving it on. If not? Maybe next time just go for the tube rather than taking those extra 10-15 seconds to put on the NC.