Efficacy of Nasal Cannula Oxygen as a Preoxygenation Adjunct in Emergency Airway Management - 21/07/16
, Anthony Lewis, MBBCh, PhD b, Brian Burns, MBBCh, MSc a, c, Matt Miller, MBChB a, bAbstract |
Study objective |
Although preoxygenation for emergency airway management is usually performed with nonrebreather face masks or bag-valve-mask devices, some clinicians also deliver supplemental high-flow oxygen by nasal cannula. We aim to measure the efficacy of supplemental nasal cannula oxygen delivery to conventional bag-valve-mask and nonrebreather face mask preoxygenation both with and without a simulated face mask leak.
Methods |
We conducted a randomized crossover trial using healthy volunteers. We randomized subjects to preoxygenation with bag-valve-mask or nonrebreather face mask. In random sequence, subjects underwent 3-minute trials of preoxygenation with oxygen through mask alone at 15 L/min, oxygen through mask at 15 L/min with standardized leak, oxygen through mask at 15 L/min+oxygen through nasal cannula at 10 L/min, and oxygen through mask at 15 L/min+oxygen through nasal cannula at 10 L/min with standardized leak. The primary outcome was single-breath exhalation end-tidal oxygen (eto2). We compared eto2 between preoxygenation modalities, using nonparametric techniques.
Results |
We enrolled 60 subjects (30 nonrebreather face mask and 30 bag-valve-mask). In scenarios without a mask leak, eto2 was similar between bag-valve-mask and bag-valve-mask+nasal cannula (mean 79% versus 75%; difference –3%; 95% confidence interval [CI] –8% to 1%). In bag-valve-mask scenarios with a mask leak, eto2 was higher for bag-valve-mask+nasal cannula than bag-valve-mask alone (mean 66% versus 41%; difference 25%; 95% CI 21% to 29%). eto2 was higher for nonrebreather face mask+nasal cannula than nonrebreather face mask (mean 67% versus 52%; difference 15%; 95% CI 12% to 18%). In nonrebreather face mask scenarios with a mask leak, eto2 was higher for nonrebreather face mask+nasal cannula than nonrebreather face mask (mean 65% versus 48%; difference 17%; 95% CI 13% to 20%).
Conclusion |
Although not aiding bag-valve-mask preoxygenation with a good mask seal, supplemental nasal cannula oxygen improved preoxygenation efficacy in the presence of a bag-valve-mask mask leak. Supplemental nasal cannula oxygen improved nonrebreather face mask preoxygenation both with and without a mask leak. Supplemental nasal cannula oxygen may be helpful for preoxygenation before emergency airway management.
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| Please see page 175 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Henry E. Wang, MD, MS |
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| Author contributions: All authors were involved with conceiving and planning the study. CH-B drafted the article and all authors contributed to its revision. MM liaised with ethical and site-specific approvals; managed the data, including quality control; and provided statistical analysis. CH-B and MM designed the trial and supervised the recruitment of volunteers, conduct of the trial, and data collection. CHB takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist and provided the following details: The study was approved by the South Eastern Sydney Local Heath District Ethics Review Committee. |
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| Clinical trial registration number: ACTRN12615000528550 |
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| A HMLHW5Q survey is available with each research article published on the Web at www.annemergmed.com. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 68 - N° 2
P. 174-180 - août 2016 Retour au numéro
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