Efficacy of Nasal Cannula Oxygen as a Preoxygenation Adjunct in Emergency Airway Management

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• 作者：Clare Hayes-Bradley ; BSc ; MBBS^a ; ^{clarehayesbradley@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; ; Anthony Lewis ; MBBCh ; PhD^b ; Brian Burns ; MBBCh ; MSc^a ; ^c ; Matt Miller ; MBChB^a ; ^b
• 刊名：Annals of Emergency Medicine
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：68
• 期：2
• 页码：174-180
• 全文大小：760 K

文摘

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.