Research & Reviews in the Fastlane 106
This study investigated the use of apneic oxygenation in the ICU. The researchers found no difference in the lowest O2 sat. However, it’s unclear if this study is applicable to the ED setting and it likely does not reflect our standard management (33% had BPAP during apnea, 40% had BVM during apnea). For now, collective anecdotes of efficacy reign while we await research in the ED setting.
The authors conclusion is that apneic oxygenation does not appear to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared to usual care. Although this is the first randomized clinical trial of apneic oxygenation my 2 cents for this study is that they excluded the sickest patients and we all know the keys to avoid desaturation are preparation, pre-oxygenation, patient positioning, and 1st pass intubation. The point of apneic oxygenation is to delay desaturation, not prevent it.
Recommended by Justin Morgenstern, Anand Swaminathan, & Salim R. Rezaie
Further information: The FELLOW Trial: An End to Apneic Oxygenation? (REBEL EM), The last breath for apnoeic oxygenation? (St Emlyn’s: JC), Podcast 158 – The FELLOW Trial on Apneic Oxygenation in ICU Patients (EMCrit)
Pediatrics
Cunningham S et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet 2015; 386(9998):1041-8. PMID: 26382998
This is another article investigating mild hypoxia (> 90%)...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Clinical Research ECG Education Emergency Medicine Intensive Care Pediatrics Public Health R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs
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