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"Preoxygenation" OR "Pre-oxygenation" OR "Pre Oxygenation" OR "Pre-Ox" OR "Apnoeic Oxygenation" OR "Ap-Ox"

M Laviola, A Das, M Chikhani, D G Bates, J G Hardman
BACKGROUND: Apnoeic oxygenation can come close to matching the oxygen demands of the apnoeic patient but does not facilitate carbon dioxide (CO2 ) elimination, potentially resulting in dangerous hypercapnia. Numerous studies have shown that high-flow nasal oxygen administration prevents hypoxaemia, and appears to reduce the rate of increase of arterial CO2 partial pressure (PaCO2 ), but evidence is lacking to explain these effects. METHODS: We extended a high-fidelity computational simulation of cardiopulmonary physiology to include modules allowing variable effects of: (a) cardiogenic oscillations affecting intrathoracic gas spaces, (b) gas mixing within the anatomical dead space, (c) insufflation into the trachea or above the glottis, and (d) pharyngeal pressure oscillation...
March 2019: British Journal of Anaesthesia
C Baillard, M Boubaya, E Statescu, M Collet, A Solis, J Guezennec, V Levy, O Langeron
BACKGROUND: The incidence of hypoxaemia related to airway management is still a matter of concern. Our aim was to determine the factors that contribute to hypoxaemia during induction of anaesthesia after a standardised preoxygenation procedure. METHODS: The study was a multicentre and prospective observational trial. It evaluated the incidence of hypoxaemia at induction of anaesthesia in adult patients. The primary endpoint was the incidence of hypoxaemia defined as pulse oximetry of arterial oxyhaemoglobin saturation (SpO2 ) <95%...
March 2019: British Journal of Anaesthesia
L A Hermez, C J Spence, M J Payton, S A R Nouraei, A Patel, T H Barnes
Clinical observations suggest that compared with standard apnoeic oxygenation, transnasal humidified rapid-insufflation ventilatory exchange using high-flow nasal oxygenation reduces the rate of carbon dioxide accumulation in patients who are anaesthetised and apnoeic. This suggests that active gas exchange takes place, but the mechanisms by which it may occur have not been described. We used three laboratory airway models to investigate mechanisms of carbon dioxide clearance in apnoeic patients. We determined flow patterns using particle image velocimetry in a two-dimensional model using particle-seeded fluorescent solution; visualised gas clearance in a three-dimensional printed trachea model in air; and measured intra-tracheal turbulence levels and carbon dioxide clearance rates using a three-dimensional printed model in air mounted on a lung simulator...
February 15, 2019: Anaesthesia
Jean-Luc Hanouz, Jean Louis Gérard, Marc Olivier Fischer
No abstract text is available yet for this article.
February 12, 2019: Intensive Care Medicine
Frank J Lodeserto, Thomas M Lettich, Salim R Rezaie
The use of the heated and humidified high-flow nasal cannula has become increasingly popular in the treatment of patients with respiratory failure through all age groups. This article will examine the main mechanisms of actions attributed to the use of the high-flow nasal cannula and review the indications in adult and pediatric populations (outside of the neonatal period). It is unclear which of the mechanisms of action is the most important, but it may depend on the cause of the patient's respiratory failure...
November 26, 2018: Curēus
Arthur Bailly, Jean-Damien Ricard, Aurelie Le Thuaut, Julie Helms, Toufik Kamel, Emmanuelle Mercier, Virginie Lemiale, Gwenhael Colin, Jean-Paul Mira, Raphaël Clere-Jehl, Jonathan Messika, Pierre-Francois Dequin, Thierry Boulain, Elie Azoulay, Benoit Champigneulle, Jean Reignier, Jean-Baptiste Lascarrou
OBJECTIVES: Severe hypoxemia is the most common serious adverse event during endotracheal intubation. Preoxygenation is performed routinely as a preventive measure. The relative efficacy of the various available preoxygenation devices is unclear. Here, our objective was to assess associations between preoxygenation devices and pulse oximetry values during endotracheal intubation. DESIGN: Post hoc analysis of data from a multicenter randomized controlled superiority trial (McGrath Mac Videolaryngoscope Versus Macintosh Laryngoscope [MACMAN]) comparing videolaryngoscopy to Macintosh laryngoscopy for endotracheal intubation in critical care...
January 30, 2019: Critical Care Medicine
Jean-Pierre Frat, Florent Joly, Arnaud W Thille
PURPOSE OF REVIEW: High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. RECENT FINDINGS: Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury...
January 28, 2019: Current Opinion in Anaesthesiology
Christophe Guitton, Stephan Ehrmann, Christelle Volteau, Gwenhael Colin, Adel Maamar, Vanessa Jean-Michel, Pierre-Joachim Mahe, Mickael Landais, Noelle Brule, Cedric Bretonnière, Olivier Zambon, Mickael Vourc'h
PURPOSE: Preoxygenation with high-flow therapy by nasal cannulae (HFNC) is now widespread in the intensive care unit (ICU). However, no large randomized study has assessed its relevance in non-severely hypoxemic patients. In a randomized controlled trial (PROTRACH study), we aimed to evaluate preoxygenation with HFNC vs. standard bag-valve mask oxygenation (SMO) in non-severely hypoxemic patients during rapid sequence intubation (RSI) in the ICU. METHODS: Randomized controlled trial including non-severely hypoxemic patients requiring intubation in the ICU...
January 21, 2019: Intensive Care Medicine
Jean-Luc Hanouz, David Lhermitte, Jean-Louis Gérard, Marc Olivier Fischer
BACKGROUND: High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S): To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING: Operating room in a primary university hospital. DESIGN: A prospective, randomised crossover study. PARTICIPANTS: Fifty healthy volunteers...
January 18, 2019: European Journal of Anaesthesiology
W Shippam, R Preston, J Douglas, J Taylor, A Albert, A Chau
High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30-70 l.min-1 oxygen flow) via nasal prongs with standard 15 l.min-1 oxygen breathing via a tight-fitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min tidal volume breathing and 30s tidal breathing followed by eight vital capacity breaths...
January 20, 2019: Anaesthesia
Si-Jia Lee, Kelvin Howyow Quek
Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a relatively new noninvasive oxygenation technique with a broad range of applications. It is used in the treatment of type one respiratory failure, as a preoxygenation tool, as a rescue and temporising measure in difficult airways, and as step-down oxygen therapy in patients after extubation. Its use has also been described in laryngeal surgeries, but they mainly involved normal-weight subjects or were used as a bridging oxygenation therapy before definitive airway is secured...
2018: Case Reports in Anesthesiology
P C F Tan, O J Millay, L Leeton, A T Dennis
BACKGROUND: Obstetric airway guidelines recommend preoxygenation in preparation for general anaesthesia to achieve end-tidal oxygen concentrations (etO2 ) of ≥90%, and mention the potential use of high-flow humidified nasal oxygen (HFNO). We investigated the new HFNO technique (Optiflow™) in term pregnant women. METHODS: Seventy-three term participants underwent a 3 min HFNO protocol (30 L min-1 for 30 s, and then 50 L min-1 for 150 s). The etO2 was assessed for the first four breaths after simulated preoxygenation...
January 2019: British Journal of Anaesthesia
Shyama Sathianathan, Rafay Nasir, Shigang Wang, Allen R Kunselman, Akif Ündar
The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different VAVD vacuum levels and venous reservoir levels in a neonatal CPB circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 arterial filter to Capiox FX05 oxygenator with integrated arterial filter. Arterial cannula flow rate to the patient was held at 500mL/min and temperature maintained at 32°C while VAVD vacuum levels (0mmHg, -15mmHg, -30mmHg, -45mmHg, -60mmHg) and venous reservoir levels (50mL, 200mL) were evaluated in both oxygenators...
December 4, 2018: Artificial Organs
Christina George, Aditya Martin, Narjeet Meena Osahan, Dootika Liddle
Growth of any kind in the oropharynx poses a threat to the airway especially during anaesthesia. Being aware of the challenges and adequately equipped to handle the situation is the duty of the anesthesiologist. Methods and Material: An eight year old girl diagnosed case of multiple mucous cysts presented to the outpatient department for excision of a lower lip mucous cyst. So an ultrasound was done which revealed a large intramural mucous cyst. After a preanaesthetic checkup she was posted for the excision of the cyst...
October 2018: Journal of Indian Association of Pediatric Surgeons
G Homfray, A Palmer, H Grimsmo-Powney, A Appelboam, G Lloyd
BACKGROUND: The elderly are perceived as a high-risk group for procedural sedation. Concern exists regarding the safety of sedation of this patient group by emergency physicians, particularly when using propofol. METHODS: We analysed prospectively collected data on patients aged 75 yr or older undergoing sedation between October 2006 and March 2017 in the emergency department of a single centre. We used the World Society of Intravenous Anaesthesia International Sedation Task Force adverse event tool, stratifying identified adverse events according to consensus agreement...
December 2018: British Journal of Anaesthesia
Paulo N Martins, Timothy A Berendsen, Heidi Yeh, Bote G Bruinsma, Maria-Louisa Izamis, Sanna Op den Dries, Andrew R Gillooly, Robert Porte, Martin L Yarmush, Korkut Uygun, James F Markmann
BACKGROUND: DCD liver grafts are known to be predisposed to primary nonfunction and ischemic cholangiopathy. Many DCD grafts are discarded because of older donor age or long warm ischemia times. Thus, it is critical to improve the quality of DCD liver grafts. Here, we have tested whether an enriched oxygen carrier added to the preservation solution can prolong graft survival and reduce biliary damage. METHODS: We assessed the ATP content decay of mouse liver grafts after cold ischemia, warm ischemia, and combined warm+cold ischemia...
November 13, 2018: Transplantation
David Kotwinski, Laura Paton, Roger Langford
The delivery of oxygen is a key component of anaesthetic practice. High flow nasal oxygen therapy is a relatively new addition to more traditional means of oxygenation which provides heated and humidified flows of controlled oxygen/air mixes achieving rates of up to 120 litres/min. The physiological benefits include nasopharyngeal dead space washout, reduced work of breathing, alveolar recruitment, maintained mucociliary function and the ability to provide apnoeic oxygenation. This article considers the current evidence for high flow nasal oxygen therapy in perioperative anaesthetic care during pre-oxygenation and intubation, management of the difficult airway, oxygenation for shared airway surgery, extubation and postoperative support, obstetric and paediatric anaesthesia...
November 2, 2018: British Journal of Hospital Medicine
J Grensemann, M Simon, S Kluge
In acute respiratory insufficiency, oxygenation and/or ventilation support by mechanical ventilation is an integral part of intensive care and emergency medicine. Effective airway management is essential to prevent hypoxic complications during the securing of the airway. This includes for example the recognition of difficult airways and adequate pre-oxygenation. While the laryngeal tube can be used in the context of cardiopulmonary resuscitation in emergency medicine, endotracheal intubation is standard in intensive care medicine...
November 5, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
J C Schäuble, T Heidegger
Several national airway task forces have recently updated their recommendations for the management of the difficult airway in adults. Routinely responding to airway difficulties with an algorithm-based strategy is consistently supported. The focus is increasingly not on tools and devices but more on good planning, preparation and communication. In the case of anticipated airway difficulties the airway should be secured when the patient is awake with maintenance of spontaneous ventilation. Unaltered a flexible bronchoscopic intubation technique is advised as a standard of care in such patients...
October 2018: Der Anaesthesist
Rajesh Kesavan, Sindhu Balakrishnan, Sunil Rajan, Shyam S Purushothaman, Rekha Varghese, Lakshmi Kumar
Background: Apneic mass movement of oxygen by applying continuous positive airway pressure (CPAP) is possible only when the airway is kept patent which helps to reduce the rate of desaturation. Aims: The aim of this study was to check the efficiency of preoxygenation and apneic oxygenation by assessing the drop in partial pressure of arterial oxygen (PaO2 ) during apnea with and without keeping an oropharyngeal airway to maintain the patency of airway. Settings and Design: This prospective observational study was conducted at a tertiary care center...
July 2018: Anesthesia, Essays and Researches
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