Apnoeic oxygenation

BACKGROUND: Difficult airway management remains a critical procedure with life-threatening adverse events. Current guidelines suggest high-flow therapy by nasal cannulae (HFNC) as a preoxygenation device in this setting. However, there is an evidence gap to support this recommendation. METHODS: The PREOPTI-DAM study is an open-label, single-centre, randomised controlled phase 3 trial done at Nantes University Hospital, France. Patients were aged 18-90 years with one major or two minor criteria of anticipated difficult airway management, and requiring intubation for scheduled surgery, were eligible...

BACKGROUND: Apnoeic oxygenation with high-flow nasal oxygen prolongs the safe apnoeic period during induction of general anaesthesia. However, central haemodynamic effects and the characteristics of central gaseous exchange remain unexplored. OBJECTIVE: To describe mean pulmonary arterial pressure along with arterial and mixed venous blood gases and central haemodynamic parameters during apnoeic oxygenation with low-flow and high-flow nasal oxygen in pigs. DESIGN: Experimental crossover study...

STUDY OBJECTIVE: Investigate a low-cost, nasopharyngeal apnoeic oxygenation technique, establish its efficacy, and compare it to preoxygenation only in an obese population. The study's hypothesis was that nasopharyngeal apnoeic oxygenation at 18 l.min-1 would significantly prolong safe apnoea time compared to preoxygenation alone. DESIGN: Randomised controlled study. SETTING: Theatre complex of a resource constrained hospital. PATIENTS: 30 adult, obese (BMI ≥ 35 kg...

BACKGROUND AND AIMS: Anaesthesia for endolaryngeal surgery is specialised to provide almost a tubeless surgical field. During the coronavirus disease-19 pandemic, when most of the surgeries were staggered, we being in a tertiary referral centre for airway surgery had to modify our existing techniques and observed an evolution in the anaesthesia management which we could continue even in the postpandemic period. Hence, we conducted this retrospective study to analyse the reliability of our locally developed apnoeic high-flow oxygenation technique (AHFO) for endolaryngeal procedures...

INTRODUCTION: Nearly half of neonatal intubations are complicated by severe desaturation (≥20% decline in pulse oximetry saturation (SpO2 )). Apnoeic oxygenation prevents or delays desaturation during intubation in adults and older children. Emerging data show mixed results for apnoeic oxygenation using high-flow nasal cannula (NC) during neonatal intubation. The study objective is to determine among infants ≥28 weeks' corrected gestational age (cGA) who undergo intubation in the neonatal intensive care unit (NICU) whether apnoeic oxygenation with a regular low-flow NC, compared with standard of care (no additional respiratory support), reduces the magnitude of SpO2 decline during intubation...

BACKGROUND: Combining oxygen facemask with apnoeic oxygenation using high-flow-nasal-oxygen (HFNO) for preoxygenation in the operating room has not been studied against standard oxygen facemask alone. We hypothesized that facemask-alone would be associated with lower levels of lowest end-tidal oxygen (EtO2) within 2 min after intubation in comparison with facemask combined with HFNO. METHODS: In an international prospective before-after multicentre study, we included adult patients intubated in the operating room from September 2022 to December 2022...

This recommendation summarizes the recent neonatal resuscitation guidelines of the European Resuscitation Council (ERC), but it takes into account the guidelines of the American Heart Association (AHA) and the statements of the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science with Treatment Recommendations (CoSTR) for neonatal life support. The goal of the management of the newly born infants is to support the cardiorespiratory transition. Personnel and equipment should be prepared for neonatal life support before every delivery...

Foreign body airway obstruction is considered an airway emergency and is a challenging clinical scenario for both the otolaryngologist and the anaesthetist. We present three cases of impacted upper airway metallic foreign bodies. Supra-glottic airways were obstructed and precarious. Apnoeic oxygenation utilizing high-flow nasal oxygen (HFNO), a form of tubeless anaesthetic, was used in all three cases, leading to the safe removal of the foreign bodies. Increased training, awareness and equipment availability to provide HFNO apnoeic oxygenation in the emergency setting for otolaryngology airway procedures will lead to better outcomes for patients and decreases the risk of a potential surgical airway...

Acquired tracheoesophageal fistulae are uncommon in burn patients but can occur as a complication of inhalation injury. We report a case of a 30-year-old male patient presenting after suffering from inhalation and 25% total body surface area burns. On post burns day 14 he developed a massive tracheoesophageal fistula causing refractory acute respiratory failure. Veno-venous extracorporeal membrane (VV ECMO) oxygenation was initiated without systemic anticoagulation via bi-femoral cannulation under transthoracic echocardiography guidance...

QUESTION: Human PHOX2B mutations result in life-threatening sleep-related hypoventilation (congenital central hypoventilation syndrome, CCHS). Most patients retain ventilatory activity when awake through a respiratory-related cortical network. We hypothesised that this need to mobilise cortical resources to breathe would lead to breathing-cognition interferences during cognitive loading. PATIENTS AND METHODS: Seven adult CCHS patients (five women; median age 21) performed standard neuropsychological tests (paced auditory serial addition test - calculation capacity, working memory, sustained and divided attention; trail making test - visuospatial exploration capacity, cognitive processing speed, attentional flexibility; Corsi block-tapping test - visuospatial memory, short-term memory, working memory) during unassisted breathing and under ventilatory support...

BACKGROUND: The duration of apnoeic oxygenation with high-flow nasal oxygen is limited by hypercapnia and acidosis and monitoring of arterial carbon dioxide level is therefore essential. We have performed a study in patients undergoing prolonged apnoeic oxygenation where we monitored the progressive hypercapnia with transcutaneous carbon dioxide. In this paper, we compared the transcutaneous carbon dioxide level with arterial carbon dioxide tension. METHODS: This is a secondary publication based on data from a study exploring the limits of apnoeic oxygenation...

OBJECTIVE: This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse events. DATA SOURCES: The databases searched included PubMed, Medline, CINAHL, EMBASE and The Cochrane Library. An electronic search for unpublished studies was also performed. STUDY SELECTION: We screened studies that include children undergoing intubation, studies that evaluate the use of apnoeic oxygenation by any method or device with outcomes of hypoxaemia, intubation outcome and adverse events were eligible for inclusion...

Background: The purpose of this single-centre prospective clinical study was to evaluate the correction of severe facial deformity and Obstructive sleep apnoea hypopnoea syndrome (OSAHS) in 22 patients aged from 9 to 42 years (mean 20.09) of bilateral Temporomandibular joint ankylosis. Materials and Methodology: Patients underwent multisegment distraction using external bilateral bidirectional distractors. Facial deformity was evaluated clinically in terms of mouth opening and neck chin angle and cephalometrically in terms of corpus length (gonion-pogonion), ramal height (articulare-gonion), chin deficiency (N perpendicular to Pog and SNB)...

RATIONALE: Static apnoeas performed after an overnight fast as opposed to postprandially have been evinced to improve apnoeic performance. However, no study has explored the effect of dietary intake on apnoeic performance, cardiovascular nor splenic responses over a series of repeated apnoeas. METHOD: Ten healthy adults attended the laboratory on three separate occasions (≥48-h apart) after: a 14-h fast (F14), 1-h post consumption of a high-calory-high-carbohydrate (HCHC) or a low-calory-low-carbohydrate (LCLC) based-meal...

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Apnoeic oxygenation is not only important for patients who cannot be intubated/ventilated, but also can be routinely employed when planning to secure the airway.We aimed to compare safe apnoea times between patients receiving modified nasopharyngeal oxygen therapy and those receiving high-flow nasal oxygen therapy (HFNO) following the induction of general anaesthesia.This was a single-centre, randomized controlled clinical study. Eighty-four female patients undergoing elective laparoscopic gynaecological surgery under general anaesthesia were randomly assigned to the high-flow nasal oxygen therapy group (Group HFNO) or the modified nasopharyngeal oxygen therapy group (Group Naso)...

Peri-intubation oxygen administration to the pregnant patient during induction of general anaesthesia is critical to avoiding hypoxaemia and harm to the mother and fetus. Recent modelling comparing low-flow with high-flow nasal oxygen in simulated term pregnant women of varying body habitus, taken together with previous work, suggests that face mask preoxygenation with the use of low-flow or high-flow nasal oxygen during the period of apnoea prolongs the safe apnoea period, with the benefit varying by body habitus...

BACKGROUND: The impact of different respiratory strategies at birth on the preterm lung is well understood; however, concerns have been raised that lung recruitment may impede cerebral haemodynamics. This study aims to examine the effect of three different ventilation strategies on carotid blood flow, carotid artery oxygen content and carotid oxygen delivery. METHODS: 124-127-day gestation apnoeic intubated preterm lambs studied as part of a larger programme primarily assessing lung injury were randomised to positive pressure ventilation with positive end-expiratory pressure (PEEP) 8 cmH2 O (No-RM; n = 12), sustained inflation (SI; n = 15) or dynamic PEEP strategy (DynPEEP; maximum PEEP 14 or 20 cmH2 O, n = 41) at birth, followed by 90 min of standardised ventilation...

BACKGROUND: Hypoxaemia during general anaesthesia can cause harm. Apnoeic oxygenation extends safe apnoea time, reducing risk during airway management. We hypothesised that low-flow nasal oxygenation (LFNO) would extend safe apnoea time similarly to high-flow nasal oxygenation (HFNO), whilst allowing face-mask preoxygenation and rescue. METHODS: A high-fidelity, computational, physiological model was used to examine the progression of hypoxaemia during apnoea in virtual models of pregnant women in and out of labour, with BMI of 24-50 kg m-2 ...

Background and Aims: This trial aimed to assess the safety and efficacy of oxygenation using a high-flow nasal cannula (HFNC) compared with the standard apnoeic oxygenation technique during foreign body (FB) removal by a rigid bronchoscope. Methods: A prospective, blinded, randomised, controlled trial was conducted on subjects planned for FB removal by a rigid bronchoscope. Inclusion criteria were male and female patients aged between 10 and 40 years. The primary outcome was the lowest oxygen saturation level monitored by pulse oximeter during the procedure, and the secondary outcome was the incidence of postoperative atelectasis...