Abstract
Aim: During rapid sequence intubation (RSI), the O2 reserve limits the intubation duration. The study objective was to examine the impact of RSI on arterial blood gases (ABG) during the preoxygenation phase. Methods: This open, prospective clinical study examined samples of patients who had endotracheal intubation (ETI) as RSI between March 2014 and September 2014 in our emergency department. The variations in ABG PaO2 and PaCO2 before and after preoxygenation and after intubation were examined and compared with demographic and clinical variables. Results: The study included 67 patients (46 male, 21 female) with a mean age of 69.9 years. SBP, DBP, and MABP decreased, while pulse rate and SpO2 increased. No difference was observed between PaO2 values and demographic and clinical variables; however, a statistically significant relationship was found between the difference (D) between PaO2 values measured after endotracheal tracheal intubation (ETI) and after preoxygenation and the ABG SpO2 and the SpO2 classification before preoxygenation. Conclusion: The relationship between SpO2 and its classification following ETI and increased ABG SpO2 was statistically significant. Our real-life study emphasises that deciding on intubation without desaturating patients could have positive effects on intubation success. Regardless, increasing SpO2 prior to ETI will contribute positively to the O2 reserve by the end of ETI. The DPaO2 , before and after preoxygenation, was not affected by age; gender; body mass index (BMI) and its classification; GCSS; vital signs and ABG findings gathered before preoxygenation; respiration rate (RR) during preoxygenation; preoxygenation duration; oral air passage usage or air leakage.
Highlights
Rapid sequence intubation (RSI) is the standard airway management practice in the emergency department (ED) because it provides rapid sedation and paralysis
No difference was observed between PaO2 values and demographic and clinical variables; a statistically significant relationship was found between the difference (Δ) between PaO2 values measured after endotracheal tracheal intubation (ETI)
Our real-life study emphasises that deciding on intubation without desaturating patients could have positive effects on intubation success
Summary
Rapid sequence intubation (RSI) is the standard airway management practice in the emergency department (ED) because it provides rapid sedation and paralysis. Clinical treatment requires quick recognition of respiratory failure since a decision for endotracheal intubation (ETI) may be difficult for emergency physicians, and the ETI must be performed fast when indicated. In RSI, all patients, including those without manifest hypoxia, are preoxygenated. Preoxygenation provides a security buffer between hypoventilation and apnea and prolongs the safe apnea duration(the period required to maintain peripheral capillary oxygen saturation (SpO2) between 88–90% until a permanent airway is ensured). If preoxygenation is not performed, the SpO2 drops to very critical levels (< 70%) within minutes [1, 2, 3]
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