ADVANCED OXYGEN DELIVERY 2018
Urgent Need to add Hi Delivery Nasal Oxygen to Algorithms
The tool kit available for airway management has evolved rapidly in the last 20 years to include the following :
1. There are algorithms such as the ASA Difficult Airway Algorithm 2013, the DAS (UK) Algorithm and the Canadian Focus Group Recommendations.
2. Training including Airway Fellowships have been developed.
3. Equipment has been developed and proven to be effective in situations where Practitioners have been trained to a competent level with the devices prior to emergency events.
4. The Airway Tool Kit includes:
a. oxygen delivery by preoxygenation, nasal oxygenation, Nasal CPAP (as Per James Tse),
and Hi Flow oxygen such as Thrive.
b. Oral and nasal airways
c. Supraglottic Airways
d. Tracheal Intubation- Direct Laryngoscopy
e. Tracheal Intubation- Video Laryngoscopy
f. Tracheal Intubation - Flexible Scope application
g. Direct Surgical Airway
h. ECMO
N Shallik and A Karmakar , Doha Qatar , online June 25, 2018
DOI:https://doi.org/10.1016/j.bja.2018.05.052
The above authors have suggested that there is urgency to place the advanced methods of Oxygen Delivery such as Hi Flow Nasal O2 into the Difficult Airway algorithms forthwith.
The world moves at a different pace at this time.
The ASA Algorithm 2013 should be updated immediately to avoid a gap in application of advanced oxygenation methods known to extend the period of acceptable blood oxygen levels by minutes . These nethods include high flow (Thrive) and also Nasal CPAP oxygen .
The risk of inclusion of these excellent methods as an urgent need is close to zero because there are few side effects and the oxygen provides an extended working and thinking time for care givers.
