Apnoeic oxygenation for emergency anaesthesia of pre-hospital trauma patients
| Autor: | Samy Sadek, David Lockey, Marius Rehn, Ainsley Heywoth, Kate Crewdson |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Apnoeic oxygenation medicine.medical_treatment Critical Care and Intensive Care Medicine Trauma Clinical endpoint Medicine Intubation Cannula Humans Anesthesia Prospective Studies Airway Management Adverse effect Hypoxia Original Research business.industry Standard treatment Major trauma Incidence (epidemiology) lcsh:Medical emergencies. Critical care. Intensive care. First aid Oxygen Inhalation Therapy lcsh:RC86-88.9 Hypoxia (medical) Middle Aged medicine.disease Pre-oxygenation Emergency Emergency Medicine Wounds and Injuries Airway management Female pre-hospitale tjenester Medisinske Fag: 700::Klinisk medisinske fag: 750::Traumatologi: 783 [VDP] medicine.symptom business Emergency Service Hospital anestesi |
| Zdroj: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 29, Iss 1, Pp 1-7 (2021) |
| ISSN: | 1757-7241 |
| Popis: | Background Efficient and timely airway management is universally recognised as a priority for major trauma patients, a proportion of whom require emergency intubation in the pre-hospital setting. Adverse events occur more commonly in emergency airway management, and hypoxia is relatively frequent. The aim of this study was to establish whether passive apnoeic oxygenation was effective in reducing the incidence of desaturation during pre-hospital emergency anaesthesia. Methods A prospective before-after study was performed to compare patients receiving standard care and those receiving additional oxygen via nasal prongs. The primary endpoint was median oxygen saturation in the peri-rapid sequence induction period, (2 minutes pre-intubation to 2 minutes post-intubation) for all patients. Secondary endpoints included the incidence of hypoxia in predetermined subgroups. Results Of 725 patients included; 188 patients received standard treatment and 537 received the intervention. The overall incidence of hypoxia (first recorded SpO2 2 2 Median SpO2 was 100% vs. 99% for the standard vs. intervention group. There was a statistically significant benefit from apnoeic oxygenation in reducing the frequency of peri-intubation hypoxia (SpO2 2 > 95%, p = 0.0001. The other significant benefit was observed in the recovery phase for patients with severe hypoxia prior to intubation. Conclusion Apnoeic oxygenation did not influence peri-intubation oxygen saturations, but it did reduce the frequency and duration of hypoxia in the post-intubation period. Given that apnoeic oxygenation is a simple low-cost intervention with a low complication rate, and that hypoxia can be detrimental to outcome, application of nasal cannulas during the drug-induced phase of emergency intubation may benefit a subset of patients undergoing emergency anaesthesia. |
| Databáze: | OpenAIRE |
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