Efficacy and Safety of Using High-Flow Nasal Oxygenation in Patients Undergoing Rapid Sequence Intubation.

OBJECTIVE

To assess the efficacy and safety of high-flow nasal oxygen (HFNO) therapy in patients undergoing rapid sequence intubation (RSI) for emergency abdominal surgery.

METHODS

HFNO of 60 L.min at an inspiratory oxygen fraction of 1 was delivered 4 min before laryngoscopy and maintained until the patient was intubated, and correct intubation was verified by the appearance of the end-tidal CO (EtCO) waveform. Transcutaneous oxygenation (SpO), heart rate and non-invasive mean arterial pressure were monitored at baseline (T0), after 4 min on HFNO (T1) and at the time of laryngoscopy (T2) and endotracheal intubation (ETI) (T3). An SpO of <3% from baseline was recorded at any sampled time. The value of EtCO at T3 was registered after two mechanical breaths. The apnoea time was defined as the time from the end of propofol injection to ETI. RSI was performed with propofol, fentanyl and rocuronium.

RESULTS

Forty-five patients were enrolled. SpO levels showed a statistically significant increase at T1, T2 and T3 compared with those at T0 (p<0.05); median SpO% (interquartile range) was 97% (range, 96%-99%) at T0, 99% (range, 99%-100%) at T1, 99% (range, 99%-100%) at T2 and 99% (range, 99%-100%) at T3. Minimal SpO was 96%; no patient showed an SpO of <3% from baseline; mean EtCO at the time of ETI was 36±4 mmHg. Maximum apnoea time was 12 min.

CONCLUSION

HFNO is an effective and safe technique for pre-oxygenation in patients undergoing rapid sequence induction of general anaesthesia for emergency surgery.