Novel Oxygenation Techniques for Airway Management
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AIRWAY MANAGEMENT (LC BERKOW, SECTION EDITOR)
Novel Oxygenation Techniques for Airway Management Lorraine J. Foley 1 Accepted: 14 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Significant morbidity is caused by hypoxemic events during procedural sedation, induction for tracheal intubation, and postoperatively after anesthesia in the postoperative care unit. Novel and advanced oxygenation techniques will be discussed to help prevent hypoxemia and improve patient outcome. Recent Findings ASA closed claims outside the operating room showed an increase in oxygen desaturation during moderate to deep sedation with no or conventional oxygenation. Non-invasive positive pressure oxygenation (NPPO) reduces the incidence of oxygen desaturation during procedural sedation, during induction for tracheal intubation, and postoperatively after anesthesia in the postoperative care unit. Summary Non-invasive positive pressure oxygenation (NPPO) techniques such as high flow nasal cannula and nasal CPAP increase apneic time during intubation as well as decrease hypoxemia during procedural sedation, during induction for tracheal intubation, and post extubation compared with conventional oxygenation. Keywords Hypoxemia . High flow nasal oxygenation . Continuous positive airway pressure . Obstructive upper airway . Apneic oxygenation . Sedation
Introduction Hypoxemia can cause significant morbidity and mortality. Oxygen desaturation below 70% puts patients at risk for dysrhythmias, hemodynamic decompensation, hypoxic brain injury, and death [1]. Hypoxemic events occur during procedural sedation, during induction for tracheal intubation, and postoperatively after anesthesia in the postoperative care unit. The causes of hypoxemia are due to decrease in level of consciousness or respiratory drive which leads to upper airway obstruction, hypoventilation, and/or apnea. More and more procedures are being performed under anesthesia outside the operating room. Anesthesia-related malpractice closed claims were reviewed comparing anesthesia given in remote locations (NORA) versus the operating room (OR). The proportion of deaths was far greater (54%) in the NORA group than in the OR (24%). Of the NORA group, This article is part of the Topical Collection on Airway Management * Lorraine J. Foley [email protected] 1
Tufts School of Medicine, Anesthesiologist Winchester Hospital of Beth Israel/Lahey Health, Boston, MA, USA
58% of cases were performed under monitored anesthesia care (MAC), with inadequate oxygenation/ventilation being the most common specific damaging event [2]. Management of the difficult airway, during induction for tracheal intubation, requiring multiple attempts to intubate can lead to an increased incidence of hypoxemia and “can’t intubate, can’t ventilate situation” in and outside the operating room [1]. Another area of concern for hypoxemia is in the postoperative care unit (PACU) which occurs more frequently than documented. A prospective blinded observa
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