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Chapter 8 - Oxygenation: before, during and after Airway Management

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

By
Søren Steemann Rudolph  and
Anil Patel
Edited by
Tim Cook  and
Michael Seltz Kristensen
Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

Oxygenation is the primary aim of all airway management. The shape of the oxyhaemoglobin dissociation curve determines onset of hypoxaemia and means that when it occurs it can progress rapidly and severely. Hypoxaemia causes rapid damage to living tissues, most importantly the brain. Oxygenation strategies are required including delivering oxygen before, during and after airway management. Low flow oxygenation techniques are traditionally employed and apnoeic oxygenation has been rarely used. Newer high flow oxygen delivery systems enable effective pre-oxygenation and apnoeic oxygenation and can be used both during complex airway management or as an alternative to instrumenting the airway during surgery.

Keywords

Airwayapnoeic oxygenationhigh flowhypoxaemiahypoxialow flowoxygenoxygenationpre-oxygenation
Type
Chapter
Information
Core Topics in Airway Management , pp. 72 - 79
Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Hermez, LA, Spence, CJ, Payton, MJ, et al. (2019). A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE). Anaesthesia, 74, 441–449.CrossRefGoogle ScholarPubMed
Higgs, A, McGrath, BA, Goddard, C, et al.; Difficult Airway Society; Intensive Care Society; Faculty of Intensive Care Medicine; Royal College of Anaesthetists. (2018). Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia, 120, 323–352.CrossRefGoogle ScholarPubMed
Patel, A, Nouraei, SAR. (2015). Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia, 70, 323–329.CrossRefGoogle ScholarPubMed
Sakles, JC, Chiu, S, Mosier, J, Walker, C, Stolz, U. (2013). The importance of first pass success when performing orotracheal intubation in the emergency department. Academic Emergency Medicine, 20, 71–78CrossRefGoogle ScholarPubMed
Simon, M, Wachs, C, Braune, S, et al. (2016). High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respiratory Care, 61, 1160–1167.CrossRefGoogle ScholarPubMed
Weingart, SD, Levitan, RM. (2012). Preoxygenation and prevention of desaturation during emergency airway management. Annals of Emergency Medicine, 59, 165–175.CrossRefGoogle ScholarPubMed

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