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Apneic Oxygenation Prevents Desaturation During Intubation

Daniel J. Pallin, MD, MPH

 

Two meta-analyses used different methods but have similar findings.

 

Apneic oxygenation is the delivery of high-flow oxygen by nasal cannula during endotracheal intubation. Two separate meta-analyses provide pooled results from trials of apneic oxygenation.

 

The first meta-analysis included 8 studies and 1953 patients in critical care settings. It found that the risk for “clinically significant hypoxemia” (reduction of oxygen saturation to <90%–93%) was 28% in the usual care group and 19% in the apneic oxygenation group — a reduction of 30% — without any heterogeneity in outcome across studies.

 

The second meta-analysis included 6 studies and 1822 patients in prehospital and emergency
department settings. It found that the risk for “critical desaturation” (reduction of oxygen saturation to <80%) was halved (relative risk, 0.51) with apneic oxygenation in the three studies that used this outcome. The risk of desaturation to below 93%–95% was reduced by 24% (RR, 0.76) in the five studies that used this outcome. There was substantial heterogeneity in this outcome among studies.

 

Comment:
I’ve been skeptical about the physiological plausibility of apneic oxygenation, but evidence
to support it is accumulating. It’s time to say that we should use high-flow nasal cannula oxygenation during laryngoscopy for all emergent intubations.

 

Citation(s):
Pavlov I et al. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. Am J Emerg Med 2017 Jun 15; [e-pub].
(http://dx.doi.org/10.1016/j.ajem.2017.06.029)

Binks MJ et al. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis. Am J Emerg Med 2017 Jun 24; [e-pub].
(http://dx.doi.org/10.1016/j.ajem.2017.06.046)
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