The Emergency Medicine department at University of Arizona Hospital has produced yet another insight into the practice of challenging airway management. These studies are difficult to do because of the fluid nature of services that provide large amounts of daily care.
The question posed by Sakles , Mosier and team was : What is the benefit of provision of Apnoeic Oygenation during RSI in a department where care is provided by Residents who are heavy users of Video Laryngoscopy and in patients who are proven to have Intracranial Hemorrhage . It is widely accepted now that Hypoxemia in this vulnerable group has a marked impact on survival and outcome and must be avoided at all cost.
From a base group of 856 patients undergoing RSI 127 patients had ICH and were intubated by EM Residents of various experience and had a start saturation greater than 90% and had complete data for the period of care. 72 patients had Apneic oxygenation with a nasal cannula with flow of 15 litres or more throughout the RSI process using a non-rebreathing mask and 55 had a standard 3 minute pre oxygenation strategy with a mask.
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