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Apneic oxygenation

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https://www.readbyqxmd.com/read/29095183/the-effect-of-apneic-oxygenation-on-reducing-hypoxemia-during-rapid-sequence-induction-and-intubation-in-the-acutely-ill-or-injured
#1
Autumn Riddell
Apneic oxygenation during intubation is the application of oxygen via a nasal cannula, which is left in place throughout laryngoscopy. The flow rate of oxygen is set to at least 15 L/min and theoretically reduces the risk of oxygen desaturation and hypoxemia during the procedure. Over the last 5 years, there have been several studies published on this topic with differing results. Despite conflicting results, use of apneic oxygenation is becoming more prevalent and is being implemented into standard operating procedures in some clinical settings...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29095178/changing-the-emergency-department-s-practice-of-rapid-sequence-intubation-to-reduce-the-incidence-of-hypoxia
#2
Michael D Gooch, Eric Roberts
Rapid sequence intubation (RSI) is an advanced procedure performed by nurse practitioners in the emergency department (ED). Hypoxia is one of the most common complications associated with RSI, which may lead to serious sequela, including death. Hypoxia may result from medications that are given to facilitate the procedure or the underlying disease process. Without preventive measures, oxygen levels may fall rapidly when patients are no longer actively breathing. The incidence of RSI-induced hypoxia may be mitigated with proper education, preoxygenation, positioning, and the utilization of passive (apneic) oxygenation...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29063722/a-quality-improvement-initiative-to-increase-the-safety-of-pediatric-emergency-airway-management
#3
Elliot Long, Domenic R Cincotta, Joanne Grindlay, Stefano Sabato, Emmanuelle Fauteux-Lamarre, David Beckerman, Terry Carroll, Nuala Quinn
BACKGROUND: Emergency airway management is commonly associated with life-threatening hypoxia and hypotension which may be preventable. AIMS: The aim of this quality improvement study was to reduce the frequency of intubation-related hypoxia and hypotension. METHODS: This prospective quality improvement study was conducted over 4 years in the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. A preintervention cohort highlighted safety gaps and was used to design study interventions, including an emergency airway algorithm, standardized airway equipment, a preintubation checklist and equipment template, endtidal carbon dioxide monitoring, postintubation team debriefing, and multidisciplinary team training...
October 24, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29051828/intubation-following-high-dose-rocuronium-in-a-cat-with-protracted-laryngospasm
#4
Graeme M Doodnaught, Daniel Sj Pang
CASE SUMMARY: An 11-year-old spayed female domestic shorthair cat with a history of laryngospasm at induction of general anesthesia presented for dental evaluation and treatment. The cat was premedicated with hydromorphone (0.05 mg/kg) and alfaxalone (0.5 mg/kg) intravenously, pre-oxygenated for 5 mins (3 l/min, face mask) and anesthesia was induced with alfaxalone (to effect) intravenously. Lidocaine (0.1 ml, 2%) was applied topically to the arytenoid cartilages following loss of jaw tone...
July 2017: JFMS open reports
https://www.readbyqxmd.com/read/28915219/intrabronchial-catheter-resuscitation-for-respiratory-and-cardiorespiratory-arrest
#5
Jeffrey S Wolf, Andrea Hebert, Pablo Sanchez, Marniker Wijesinha, Scott Shapiro, Robert Morales, Aldo T Iacono
INTRODUCTION: We sought to determine whether intrabronchial oxygenation would provide adequate gas exchange during both anesthesia induced apneic and cardiopulmonary arrest and cardiac massage (CPR). METHODS: Ten pigs underwent general anesthesia with mechanical ventilation. Blood gases were measured in each animal at 4 min intervals for up to 28 min. An intrabronchial catheter (4 L/min O2) was inserted through an endotracheal tube after respirator cessation. Group A animals (6) were resuscitated with the catheter but without CPR...
September 14, 2017: Shock
https://www.readbyqxmd.com/read/28891821/heart-rate-variability-as-a-feeding-intervention-outcome-measure-in-the-preterm-infant
#6
Britt F Pados, Suzanne M Thoyre, George J Knafl, William Brant Nix
BACKGROUND: Feeding interventions for preterm infants aim to reduce the physiologic stress of feeding to promote growth. Heart rate variability (HRV) is a potential noninvasive measure of physiologic stress that may be useful for evaluating efficacy of feeding interventions. PURPOSE: To evaluate whether HRV is a sensitive measure of physiologic stress compared with standard physiologic outcomes in the context of a feeding intervention study. METHODS: This was a secondary analysis of a within-subjects, cross-over design study comparing usual care feeding with a gentle, coregulated (CoReg) feeding approach in 14 infants born less than 35 weeks' postmenstrual age...
October 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/28791755/emergency-department-use-of-apneic-oxygenation-versus-usual-care-during-rapid-sequence-intubation-a-randomized-controlled-trial-the-endao-trial
#7
Nicholas Caputo, Ben Azan, Rui Domingues, Lee Donner, Mark Fenig, Douglas Fields, Robert Fraser, Karlene Hosford, Richard Iuorio, Marc Kanter, Moira McCarty, Thomas Parry, Andaleeb Raja, Mary Ryan, Blaine Williams, Hemlata Sharma, Daniel Singer, Chris Shields, Sandra Scott, Jason R West
OBJECTIVES: Desaturation leading to hypoxemia may occur during rapid sequence intubation (RSI). Apneic oxygenation (AO) was developed to prevent the occurrence of oxygen desaturation during the apnea period. The purpose of this study was to determine if the application of AO increases the average lowest oxygen saturation during RSI when compared to usual care (UC) in the emergency setting. METHODS: A randomized controlled trial was conducted at an academic, urban, Level I trauma center...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28766977/surgical-management-of-supraglottic-stenosis-using-intubationless-optiflow
#8
Kenric Tam, Caroline Jeffery, C Kwang Sung
OBJECTIVE: Airway management during endoscopic surgical treatment of supraglottic and pharyngeal stenosis is often challenging and can be accomplished by various means, including tracheostomy, jet ventilation, or direct laryngoscopy. We describe CO2 laser excision of supraglottic-pharyngeal stenosis using intubationless Optiflow high-flow nasal cannula (HFNC). METHODS: A 55-year-old male presented with dyspnea and dysphagia secondary to severe supraglottic-pharyngeal stenosis in the setting of previous chemoradiation for a T0N2aM0 squamous cell carcinoma...
September 2017: Annals of Otology, Rhinology, and Laryngology
https://www.readbyqxmd.com/read/28759496/addition-of-nasal-cannula-can-either-impair-or-enhance-preoxygenation-with-a-bag-valve-mask-a-randomized-crossover-design-study-comparing-oxygen-flow-rates
#9
David McQuade, Matthew R Miller, Clare Hayes-Bradley
BACKGROUND: A critical safety component of emergency anesthesia is the avoidance of hypoxemia during the apneic phase of a rapid sequence intubation. Preoxygenation with a bag valve mask (BVM) or anesthetic circuit may be improved with supplemental oxygen by nasal cannula (NC) if there is a mask leak. In addition, NC is recommended for apneic oxygenation after induction and may be placed before preoxygenation. However, the optimum NC flow rate for preoxygenation or whether the presence of NC alone creates a mask leak remains unclear...
July 26, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28737623/an-observational-study-of-severe-pertussis-in-100-infants-%C3%A2-120-days-of-age
#10
James D Cherry, Kristen Wendorf, Brooke Bregman, Deborah Lehman, Delma Nieves, John S Bradley, Wilbert H Mason, Linette Sande-Lopez, Merrick Lopez, Myke Federman, Tempe Chen, Dean Blumberg, Samantha Johnston, Hayden T Schwenk, Peggy Weintrub, Kevin K Quinn, Kathleen Winter, Kathleen Harriman
BACKGROUND: Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal. METHODS: All pertussis cases ≤ 120 days of age admitted to a pediatric intensive care unit (PICU) in California between October 1, 2013 and April 25, 2015 were evaluated. RESULTS: Of 100 pertussis patients ≤ 120 days of age admitted to PICU's, there were 5 deaths. The white blood cell (WBC) counts in the fatal cases were significantly higher than in the non-fatal cases...
July 20, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28712606/effectiveness-of-apneic-oxygenation-during-intubation-a-systematic-review-and-meta-analysis
#11
REVIEW
Lucas Oliveira J E Silva, Daniel Cabrera, Patricia Barrionuevo, Rebecca L Johnson, Patricia J Erwin, M Hassan Murad, M Fernanda Bellolio
STUDY OBJECTIVE: We conduct a systematic review and meta-analysis to evaluate the effectiveness of apneic oxygenation during emergency intubation. METHODS: We searched Ovid MEDLINE, Ovid EMBASE, Ovid CENTRAL, and Scopus databases for randomized controlled trials and observational studies from 2006 until July 2016, without language restrictions. Gray literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate first-pass success rates, incidence of hypoxemia, and lowest peri-intubation SpO2 between apneic oxygenation and standard oxygenation cases...
October 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28684195/apneic-oxygenation-during-intubation-in-the-emergency-department-and-during-retrieval-a-systematic-review-and-meta-analysis
#12
REVIEW
Matthew J Binks, Rhys S Holyoak, Thomas M Melhuish, Ruan Vlok, Elyse Bond, Leigh D White
BACKGROUND: Hypoxemia increases the risk of intubation markedly. Such concerns are multiplied in the emergency department (ED) and during retrieval where patients may be unstable, preparation or preoxygenation time limited and the environment uncontrolled. Apneic oxygenation is a promising means of preventing hypoxemia in this setting. AIM: To test the hypothesis that apnoeic oxygenation reduces the incidence of hypoxemia during endotracheal intubation in the ED and during retrieval...
October 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28664391/dobutamine-a-%C3%AE-1-adrenoceptor-agonist-increases-cerebral-oxygenation-during-acute-anemia-and-apneic-hypoxia
#13
Tadayoshi Kurita, Shingo Kawashima, Koji Morita, Yoshiki Nakajima
BACKGROUND: β1 blockers increase the risk of cerebral hypoxia during acute anemia and apneic hypoxia. We hypothesized that β1 stimulants conversely increase cerebral tolerance to anemia and hypoxia. METHODS: After induction with isoflurane, twelve swine (mean ± SD: 25.2 ± 0.6 kg) received 200 µg kg(-1) min(-1) landiolol and 20 µg kg(-1) min(-1) dobutamine. Reversal of the order of drug administration was performed in six animals each. Before and during each drug infusion, apnea was induced until reaching <70% oxygen saturation (SpO2) after 5 min of 100% oxygen ventilation...
June 29, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28647137/apneic-oxygenation-reduces-the-incidence-of-hypoxemia-during-emergency-intubation-a-systematic-review-and-meta-analysis
#14
REVIEW
Ivan Pavlov, Sofia Medrano, Scott Weingart
STUDY OBJECTIVE: Apneic oxygenation has been advocated for the prevention of hypoxemia during emergency endotracheal intubation. Because of conflicting results from recent trials, the efficacy of apneic oxygenation remains unclear. We performed a systematic review and meta-analysis to investigate the effect of apneic oxygenation on the incidence of clinically significant hypoxemia during emergency endotracheal intubation. METHODS: MEDLINE, EMBASE, and PubMed databases were searched without language and time restrictions for studies of apneic oxygenation performed in a critical care setting...
August 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28623005/pre-oxygenation-implications-in-emergency-airway-management
#15
REVIEW
Ali Pourmand, Chelsea Robinson, Kelsey Dorwart, Francis O'Connell
Transient oxygen desaturation during emergency department intubation is an event with potentially devastating consequences. Pre-oxygenation is an important means of increasing a patient's oxygen reserve and duration of safe apnea prior to intubation. In the emergent setting, important modifications to pre-oxygenation techniques need to be considered to best manage critically ill patients. In this review, we discuss recent updates in pre-oxygenation techniques and evaluate the evidence supporting both commonly used and newly emerging techniques for pre-oxygenation, assessing nature and level of illness, the best delivery method of oxygen, using delayed sequence intubation in patients who cannot tolerate non-invasive pre-oxygenation and using apneic oxygenation via nasal cannula and non-rebreather mask during intubation...
August 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28622666/real-time-automatic-apneic-event-detection-using-nocturnal-pulse-oximetry
#16
Da Woon Jung, Su Hwan Hwang, Jaegeol Cho, Byung Hun Choi, Hyun Jae Baek, Yu Jin Lee, Do Un Jeong, Kwang Suk Park
OBJECTIVE: Nocturnal pulse oximetry has been proposed as a simpler alternative to polysomnography in diagnosing sleep apnea. However, existing techniques are limited in terms of inability to provide time information on sleep apnea occurrence. This study aimed to propose a new strategy for near real-time automatic detection of apneic events and reliable estimation of apnea-hypopnea index using nocturnal pulse oximetry. METHODS: Among 230 polysomnographic recordings with apnea-hypopnea index values ranging from 0 to 86...
June 14, 2017: IEEE Transactions on Bio-medical Engineering
https://www.readbyqxmd.com/read/28505486/respiratory-support-techniques-to-avoid-desaturation-in-critically-ill-patients-requiring-endotracheal-intubation-a-systematic-review-and-meta-analysis
#17
REVIEW
Vincenzo Russotto, Andrea Cortegiani, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano
PURPOSE: To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation. METHODS: We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. RESULTS: Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients)...
October 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28412161/the-effect-of-the-apneic-period-on-the-respiratory-physiology-of-patients-undergoing-intubation-in-the-ed
#18
Jason R West, Anthony Scoccimarro, Cody Kramer, Nicholas D Caputo
OBJECTIVES: We sought to examine the physiological impact the apneic period has on the respiratory physiology of patients undergoing intubation in the emergency department and whether DAO, the delivery of 15L oxygen by nasal cannula during apnea, can affect the development of respiratory acidosis. METHODS: This was a prospective observational cohort study conducted at an urban academic level 1 trauma center. A convenience sample of 100 patients was taken. Timed data collection forms were completed during the periintubation period...
September 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28412111/apneic-oxygen-insufflation-decreases-the-incidence-of-hypoxemia-during-one-lung-ventilation-in-open-and-thoracoscopic-pulmonary-lobectomy-a-randomized-controlled-trial
#19
Dae Myung Jung, Hyun Joo Ahn, Sin-Ho Jung, Mikyung Yang, Jie Ae Kim, Su Min Shin, Suyong Jeon
OBJECTIVE: Hypoxemia is common during one-lung ventilation (OLV) for thoracic surgery. When hypoxemia occurs, surgery is interrupted for rescue ventilation. Apneic oxygen insufflation (AOI), which provides O2 without applying pressure, may prevent hypoxemia and does not interrupt surgery. The aim of this study was to determine the effectiveness of the AOI technique for preventing hypoxemia during OLV in thoracic surgery. METHODS: Patients undergoing open or thoracoscopic pulmonary lobectomy from September to December 2015 were included...
July 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28393433/nasal-high-flow-oxygen-delivery-in-children-with-abnormal-airways
#20
Susan Humphreys, Derek Rosen, Tessa Housden, Julia Taylor, Andreas Schibler
BACKGROUND: Transnasal Humidified Rapid-Insufflation Ventilatory Exchange has been shown to safely prolong the safe apnea time in well children post induction of anesthesia and is rapidly becoming a new standard for apneic oxygenation in adults. The same oxygenation technique is described as nasal high flow and can be used in infants and children at risk of apnea during anesthesia. AIM: We investigated the use of nasal high flow oxygen delivery during anesthesia in children with abnormal airways requiring tubeless airway assessment or surgery...
June 2017: Paediatric Anaesthesia
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