Preoxygenation, Reoxygenation, and Delayed Sequence Intubation in the Emergency Department

Abstract Background: The goal of preoxygenation is to provide us with a safe buffer of time before desaturation during Emergency Department intubation. For many intubations, the application of an oxygen mask is sufficient to provide us with ample time to safely intubate our patients. However, some p...

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Bibliographic Details
Published in:The Journal of emergency medicine 2011-06, Vol.40 (6), p.661-667
Main Author: Weingart, Scott D., MD
Format: Article
Language:English
Subjects:
airway management
Continuous Positive Airway Pressure
Emergency
Emergency Treatment
Humans
Hypoxia - physiopathology
Hypoxia - therapy
intubation
Intubation, Intratracheal - methods
mechanical ventilation
Oxygen Inhalation Therapy - methods
oxygenation
preoxygenation
rapid sequence intubation
Time Factors
ventilation
Ventilators, Mechanical
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Summary:Abstract Background: The goal of preoxygenation is to provide us with a safe buffer of time before desaturation during Emergency Department intubation. For many intubations, the application of an oxygen mask is sufficient to provide us with ample time to safely intubate our patients. However, some patients are unable to achieve adequate saturations by conventional means and are at high risk for immediate desaturation during apnea and laryngoscopy. For these patients, more advanced methods to achieve preoxygenation and prevent desaturation are vital. Discussion: We will review the physiology of hypoxemia and the means to correct it before intubation. Next, we will discuss apneic oxygenation as a means to blunt desaturation and the optimal way to reoxygenate a patient if desaturation does occur. Last, we will discuss the new concept of delayed sequence intubation, a technique to be used when the discomfort and delirium of hypoxia and hypercapnia prevents patient tolerance of conventional preoxygenation. Conclusions: These new concepts in preoxygenation and reoxygenation may allow safer airway management of the high-risk patient.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2010.02.014