Grant Steven, Khan Faisal, Keijzers Gerben, Shirran Mark, Marneros Leo
Gold Coast University and Robina Hospital Emergency Departments, Gold Coast, Queensland, Australia.
Griffith University, Gold Coast, Queensland, Australia.
Emerg Med Australas. 2016 Feb;28(1):67-72. doi: 10.1111/1742-6723.12524. Epub 2016 Jan 14.
To describe a simple protocol for ventilator-assisted preoxygenation (VAPOX) prior to rapid sequence intubation in the ED using a Hamilton T1 ventilator in an effort to further reduce the incidence of transient and critical hypoxaemia.
Ventilator-assisted preoxygenation includes the following steps; preparation for rapid sequence intubation as per institutional protocols, including departmental checklists. Hamilton T1 ventilator is setup in non-invasive spontaneous/timed mode with settings as described. The patient is optimally positioned and nasal cannula applied with an oxygen flow rate of 15 L/min. A face mask is applied with the jaw pulled forward using a two-handed thenar eminence grip and the ventilator is started. Preoxygenation occurs for 3 min. Drugs including neuromuscular blockers are administered, while the operator ensures the airway remains patent. The ventilator transitions into Pressure Controlled Ventilation once apnoea ensues. Nasal oxygen continues until endotracheal tube is successfully secured.
We describe a case series of the first eight consecutive adult patients on who VAPOX was applied. All eight patients were clinically deemed at high risk of oxygen desaturation. No clinically significant hypoxia occurred, and the lowest oxyhaemoglobin desaturation was 92%.
Preoxygenation using a ventilator with an open valve system may allow safe combination of non-invasive ventilation, pressure controlled ventilation and apnoeic oxygenation using nasal cannula. VAPOX may be the technique of choice to preoxygenate and apnoeic oxygenate many patients who undergo rapid sequence intubation in the ED equipped with these ventilators.
描述一种在急诊科使用汉密尔顿T1呼吸机进行快速顺序插管前的呼吸机辅助预充氧（VAPOX）简单方案，以进一步降低短暂性和严重低氧血症的发生率。
呼吸机辅助预充氧包括以下步骤；按照机构方案进行快速顺序插管准备，包括科室检查清单。将汉密尔顿T1呼吸机设置为无创自主/定时模式，并按所述设置参数。患者体位摆放合适，使用鼻导管，氧流量为15升/分钟。使用双手大鱼际肌握持法向前牵拉下颌并戴上面罩，启动呼吸机。进行3分钟预充氧。给予包括神经肌肉阻滞剂在内的药物，同时操作人员确保气道保持通畅。一旦出现呼吸暂停，呼吸机转换为压力控制通气模式。鼻导管吸氧持续至气管插管成功固定。
我们描述了一系列连续8例应用VAPOX的成年患者病例。所有8例患者临床上均被认为有高氧饱和度降低风险。未发生具有临床意义的低氧血症，最低氧合血红蛋白饱和度为92%。
使用带开放阀系统的呼吸机进行预充氧可实现无创通气、压力控制通气和使用鼻导管进行呼吸暂停氧合的安全组合。VAPOX可能是在配备这些呼吸机的急诊科对许多接受快速顺序插管的患者进行预充氧和呼吸暂停氧合的首选技术。
