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.
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.
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].
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].
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