Recommendations for improving oxygenation and preventing desaturation during ED intubations:
1. Preoxygenate patient using standard reservoir facemask with highest possible flow rate of O2, head-up position, when possible.
2. If possible, preoxygenate for 3 minutes or have patient take 8 maximal inhalation/exhalation breaths.
3. For patients who cannot achieve saturations > 93-95% with high FiO2, consider preoxygenation with PEEP, including CPAP masks, noninvasive positive-pressure ventilation, or PEEP valves on a bag-valve-mask device.
4. Provide passive oxygenation during RSI (using high-flow O2 via nasal cannula after sedatives and paralytics given) to increase duration of safe apnea in ED tracheal intubations.
6. Ventilate hypoxemic patients during onset phase of muscle relaxants in RSI prior to tracheal intubation. For fully oxygenated patients at low risk for desaturation, ventilation is not required during the onset phase of muscle relaxants.
7. Position patients to maximize upper airway patency using ear to sternal notch positioning.
References:
1. Weingart, S and Levitan, R. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Annals of Emergency Medicine 2012;59:165-75.
References:
1. Weingart, S and Levitan, R. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Annals of Emergency Medicine 2012;59:165-75.
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