Author
- Guruprasad H S
- Srilakshmi Hassan Shankar
Abstract
Apnoeic oxygenation, which is the process of providing oxygen supplementation during the period of apnoea when intubation is ongoing, is slowly emerging as a standard of care adopted by anaesthetists, intensivists and emergency physicians during elective or emergency intubations. While evidence in adult population is robust, paediatric work is ongoing and has begun to demonstrate similar benefits. Safety of the technique has been adequately established while more research is needed to clarify the pros and cons of different delivery methods and flow rates. Though the principle of apnoeic oxygenation and technique itself have been known for long, with a rich historical background deeply connected with development of mechanical ventilation itself, challenges remain in the incorporation of the relatively new practise across units. In this paper, we review the historical background, physiology and evidence for practise in the specified context of paediatric emergency intubation. We briefly discuss the practical aspects of the implementation of this useful practise for improving the safety of paediatric emergency intubations in routine care.
Reference
- Hughes G. First do no harm; then try to prevent it. Emerg Med J. 2007 May; 24(5):314.
- Scott A, Chua 0, Mitchell W, Vlok R, Melhuish T, White L. Apneic Oxygenation for Pediatric Endotracheal Intubation : A Narrative Review. J Pediatr [ntensive Care. 2019 Sep;8(3):117-121.
- Mort TC. The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA Guidelines in the remote location. J Clin Anesth. 2004 Nov; 16(7): 508-16.
- Lyons C, Callaghan M. Uses and mechanisms of apnoeic oxygenation : a narrative review. Anaesthesia. 2019 Apr;74(4):497-507.
- Hook M. An account of an experiment made by Mr. Hook, of preserving animals alive by blowing through their lungs with bellows. Philosophical Transactions of the Royal Society of London 1666; 2: 539-40.
- Volhard F. -Oberki.instliche Atmungdurch Ventilation der Trachea und eineeinfache Vorrichtungzurrhyth mischenkiinstlichen Atmung. Mi.inchener Medizinische Wochenschrift 1908;55.
- Meltzer SJ, Auer J. Continuous respiration without respiratory movements. J Exp Med 1909; 11:622-5.
- Draper WB, Whitehead RW, Spencer JN. Studies on diffusion respiration: alveolar gases and venous blood pH of dogs during diffusion respiration. Anesthesiology. 1947 Sep;8(5):524-33.
- Bartlett RG Jr, Brubach HF, Specht H. Demonstration of aventilatory mass flow during ventilation and apnea in man. J Appl Physiol. 1959 Jan;l4(1):97-101.
- Frwnin MJ, Epstein RM, Cohen G. Apneic oxygenation in man. Anesthesiology. 1959 Nov-Dec;20:789-98.
- Nahas GG. Influence of low oxygen tension on pulmonary circulation after temporary arrest of ventilation in curarized dogs. J Appl Physiol. 1956 Nov;9(3):352-8.
- Weitzner SW, King BD, lkezono E. The rate of arterial oxygen desaturation during apnea in humans. Anesthesiology. 1959 Sep-Oct;20:624-7.
- Millar RA, Morris ME. Apneic oxygenation in adrenalectomized dogs. Anesthesiology. 1961 May Jun;22:433-9.
- Heller ML, Watson TR Jr, Imredy DS. Apneic oxygenation in man: polarographic arterial oxygen tension study. Anesthesiology. 1964 Jan-Feb;25:25-30.
- Fraioli RL, Sheffer LA, Steffenson JL. Pulmonary and cardiovascular effects of apneic oxygenation in man. Anesthesiology. 1973 Dec;39(6):588-96.
- CF. Mackenzie, G. M. Barnas, J. Smalley, S. G. Park,J. Miller; Low and high flow tracheal insufflation of O2(trio) supports oxygenation in apneic dogs after ttx poisoning. Anesthesiology 1991; 75:A284.
- Gleason JM, Christian BR, Barton ED. Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation : An Integrative Literature Review. West J Emerg Med. 2018 Mar;l9(2):403-41l.
- Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165- 75.el.
- Mortimer T, Burzynski J, Kesselman M, Vallance J, Hansen G. Apneic Oxygenation during Rapid Sequence Intubation in Critically Ill Children. J Pediatr Intensive Care. 2016 Mar;5(1):28-31.
- Long E, Cincotta DR, Grindlay J, Sabata S, Fauteux Lamarre E, Beckerman D, Carroll T, Quinn N. A quality improvement initiative to increase the safety of pediatric emergency airway management. Paediatr Anaesth. 2017 Dec;27(12): 1271-1277.
- Vukovic AA, Hanson HR, Murphy SL, Mercurio D, Sheedy CA, Arnold DH. Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department. Am J Emerg Med. 2019 Jan;37(1):27-32.
- Overmann KM, Boyd SD, Zhang Y, Kerrey BT. Apneic oxygenation to prevent oxyhemoglobin desaturation during rapid sequence intubation in a pediatric emergency department. Am J Emerg Med. 2019 Aug; 37(8):1416-1421.
- Napolitano N, Laverriere EK, Craig N, Snyder M, Thompson A, Davis D, Nett S, Branca A, Harwayne Gidansky I, Sanders R Jr, Shults J, Nadkarni V, Nishisak:i A; National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Apneic Oxygenation as a Quality Improvement Intervention in an Academic PICU. Pediatr Crit Care Med. 2019 Dec;20(12):e53l e537.
- Pek JH, Tan HC, Shen G, Ong YG. Apneic Oxygenation for Emergency Intubations in the Pediatric Emergency Department-A Quality Improvement Initiative. Pediatr Qua! Saf. 2020 Feb 13;5(2):e255.
- Napolitano N, PolikoffL, Edwards L, Tarquinio KM, Nett S, Krawiec C, Kirby A, Salfity N, Tellez D, Krahn G, Breuer R, Parsons SJ, Page-Goertz C, Shults J, Nadkarni V, Nishisaki A; for National Emergency Airway Registry for Children (NEAR4KIDS) [nvestigators and Pediatric Acute Lung [njury and Sepsis Investigators (PALISI) Network. Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children. Crit Care. 2023 Jan 17; 27(1):26.
- Taha SK, Siddik-Sayyid SM, El-Khatib MF, Dagher CM, Hakki MA, Baraka AS. Nasopharyngeal oxygen insufflation following pre-oxygenation using the four deep breath technique. Anaesthesia 2006; 61: 427-30.
- RudlofB, Hohenhorst W. Use of apneic oxygenation for the performance of pan-endoscopy. Otolaryngol Head Neck Surg 2013; 149: 235-9.
- Patel A, Nouraei SA. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia 2015; 70: 323-9.
- Dias R, Dave N, Chhabria R, Shah H, Garasia M. A randomised comparative study of Miller laryngoscope blade versus Oxiport® Miller laryngoscope blade for neonatal and infant intubations. Indian J Anaesth. 2017 May;61(5):404-409.
- Wong DT, Yee AJ, Leong SM, Chung F. The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review. Can J Anaesth. 2017 Apr;64(4):416-427.
