The effect of the apneic period on the respiratory physiology of patients undergoing intubation in the ED

Jason R West, Anthony Scoccimarro, Cody Kramer, Nicholas D Caputo
American Journal of Emergency Medicine 2017, 35 (9): 1320-1323

OBJECTIVES: We sought to examine the physiological impact the apneic period has on the respiratory physiology of patients undergoing intubation in the emergency department and whether DAO, the delivery of 15L oxygen by nasal cannula during apnea, can affect the development of respiratory acidosis.

METHODS: This was a prospective observational cohort study conducted at an urban academic level 1 trauma center. A convenience sample of 100 patients was taken. Timed data collection forms were completed during the periintubation period. We report the mean ABG and end-tidal CO2 (EtCO2) values between those with normal and prolonged apnea times (>60s) and between those who received DAO and those who did not.

RESULTS: 100 patients met our inclusion criteria. There were no significant differences in the pre-RSI ABG values between those who received DAO and those who did not and between those with apnea times less than or >60s. Only in the group of patients with apnea times >60s did significant changes in respiratory physiology occur. DAO did not alter the trend in respiratory acidosis during the periintubation period. EtCO2 increased as apnea times were prolonged, and DAO altered this trend.

CONCLUSIONS: Post-RSI EtCO2 increased as apnea times were prolonged. DAO may alter this trend. Statistically significant changes in pH and PaCO2 (mean differences of 0.15 and 12.5, respectively) occurred in the group of patients who had mean apnea times of >60s but not in those with apnea times <60s.

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Terren Trott

I really like this study- however I wish I had seen a subgroup analysis of patients who were already severely acidotic and breathing 35+ times a minute. I imagine that even an apneic period of <60s may have a profound effect on pH. As many people know, intubating a severely acidotic patient can be a little anxiety provoking.


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