EBQ:ED Preoxygenation - Revision history

Danbot: Added Population section

2026-03-21T23:02:39Z

Added Population section

← Older revision		Revision as of 23:02, 21 March 2026
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	====Paralytic Usage====		====Paralytic Usage====
	The fasciculations induced by succinylcholine may cause increased oxygen use and favoring rocuronium may improve safe apenic period		The fasciculations induced by succinylcholine may cause increased oxygen use and favoring rocuronium may improve safe apenic period

			==Population==
			*ED and ICU patients requiring emergency intubation
			*Review encompasses critically ill patients across a range of pathologies requiring urgent airway management

	==Interventions==		==Interventions==

Danbot: Added Interventions, Outcomes, Criticisms, and Funding sections

2026-03-21T22:45:39Z

Added Interventions, Outcomes, Criticisms, and Funding sections

@@ Line 73: / Line 73: @@
 ====Paralytic Usage====
 The fasciculations induced by succinylcholine may cause increased oxygen use and favoring rocuronium may improve safe apenic period
 ==Review Questions==

Mlamberta: /* Conclusion */

2016-01-30T08:46:12Z

Conclusion

← Older revision		Revision as of 08:46, 30 January 2016
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	==Conclusion==		==Conclusion==
	*Preoxygenation and apneic oxygenation are crucial in emergency airway management especially prior to rapid sequence intubation in order to prevent desaturation and prolong the time to desaturation, known as the safe apenic period.		*Preoxygenation and apneic oxygenation are crucial in emergency airway management especially prior to rapid sequence intubation in order to prevent desaturation and prolong the time to desaturation, known as the safe apenic period.
	*Since standard BVMs cannot deliver PEEP, in patients with shunt physiology (i.e. pneumonia, pulmonary edema) a PEEP valve attached to the BVM or non-invavisve positive pressure ventilation (i.e. CPAP,BIPAP) should be utilized		*Since standard BVMs cannot deliver PEEP, in patients with shunt physiology (i.e. pneumonia, pulmonary edema, atelectasis) a PEEP valve attached to the BVM or non-invavisve positive pressure ventilation (i.e. CPAP,BIPAP) should be utilized

	====Preoxygenation Times:====		====Preoxygenation Times:====
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	*In patients unable to achieve oxygen saturations of >93 – 95% with 3 minutes of high FiO<sub>2</sub>		*In patients unable to achieve oxygen saturations of >93 – 95% with 3 minutes of high FiO<sub>2</sub>
	*In patients already apneic due to respiratory failure		*In patients already apneic due to respiratory failure
			*Should be used in patient's with shunt physiology to recruit alveoli

	====Patient Positioning====		====Patient Positioning====
	*Head elevation, chin lift, and jaw thrust will ~~improve patient~~ oxygenation		*Head elevation, chin lift, oropharyngeal airway and jaw thrust will ensure proper oxygenation during apnea
	*Cricoid pressure should be avoided since it can cause tracheal compression hindering ventilation		*Cricoid pressure should be avoided since it can cause tracheal compression hindering ventilation
	*Patient should be positioned with ear to sternal notch		*Patient should be positioned with ear to sternal notch

Ostermayer at 00:00, 6 April 2014

2014-04-06T00:00:06Z

← Older revision		Revision as of 00:00, 6 April 2014
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	\| year= 2012		\| year= 2012
	\| volume=59		\| volume=59
	\| issue= =3		\| issue=3
	\| pages=165-75		\| pages=165-75
	\| pmid=22578923		\| pmid=22578923

Ostermayer: /* Oxygen Sources for Preoxygenation: */

2014-04-05T22:40:40Z

Oxygen Sources for Preoxygenation:

← Older revision		Revision as of 22:40, 5 April 2014
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	#The FiO<sub>2</sub> can be increased to ≥90% with flow rates > 30L/min		#The FiO<sub>2</sub> can be increased to ≥90% with flow rates > 30L/min
	::OR		::OR
	:Consider adding a n'''~~asal~~ cannula increased >10L/min''' or as tolerated by patient along with nonrebreather mask		:Consider adding a '''nasal cannula increased >10L/min''' or as tolerated by patient along with nonrebreather mask

	*'''Positive pressure ventilation~~:'''~~		=====Positive pressure ventilation=====
	**In patients unable to achieve oxygen saturations of >93 – 95% with 3 minutes of high FiO<sub>2</sub>		*In patients unable to achieve oxygen saturations of >93 – 95% with 3 minutes of high FiO<sub>2</sub>
	*In patients already apneic due to respiratory failure		*In patients already apneic due to respiratory failure

Ostermayer: /* Oxygen Sources for Preoxygenation: */

2014-04-05T22:39:21Z

Oxygen Sources for Preoxygenation:

← Older revision		Revision as of 22:39, 5 April 2014
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	#Standard nonrebreather at 15L/minute will deliver 60 – 70% FiO2		#Standard nonrebreather at 15L/minute will deliver 60 – 70% FiO2
	#The FiO<sub>2</sub> can be increased to ≥90% with flow rates > 30L/min		#The FiO<sub>2</sub> can be increased to ≥90% with flow rates > 30L/min
	OR		::OR
			:Consider adding a n'''asal cannula increased >10L/min''' or as tolerated by patient along with nonrebreather mask
	:Consider adding a ~~nasal~~ cannula increased >10L/min or as tolerated by patient along with nonrebreather mask

	*'''Positive pressure ventilation:'''		*'''Positive pressure ventilation:'''

Ostermayer: /* Preoxygenation Times: */

2014-04-05T22:39:02Z

Preoxygenation Times:

← Older revision		Revision as of 22:39, 5 April 2014
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	====Preoxygenation Times:====		====Preoxygenation Times:====
	*3 minutes of tidal volume breathing with a high FiO2 source (15L nasal cannula + 100% non rebreather on patient at the same time)		*3 minutes of tidal volume breathing with a high FiO2 source (15L nasal cannula + 100% non rebreather on patient at the same time)
	OR		::OR
	*8 vital capacity breaths (maximal inhalation and maximal exhalation) with a high FiO2 source		*8 vital capacity breaths (maximal inhalation and maximal exhalation) with a high FiO2 source

Ostermayer: /* Conclusion */

2014-04-05T22:38:36Z

Conclusion

← Older revision		Revision as of 22:38, 5 April 2014
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	====Preoxygenation Times:====		====Preoxygenation Times:====
	3 minutes of tidal volume breathing with a high FiO2 source (15L nasal cannula + 100% non rebreather on patient at the same time)		*3 minutes of tidal volume breathing with a high FiO2 source (15L nasal cannula + 100% non rebreather on patient at the same time)
	OR		OR
	8 vital capacity breaths (maximal inhalation and maximal exhalation) with a high FiO2 source		*8 vital capacity breaths (maximal inhalation and maximal exhalation) with a high FiO2 source

	====Oxygen Sources for Preoxygenation:====		====Oxygen Sources for Preoxygenation:====
Line 47:		Line 47:
	#The FiO<sub>2</sub> can be increased to ≥90% with flow rates > 30L/min		#The FiO<sub>2</sub> can be increased to ≥90% with flow rates > 30L/min
	OR		OR
	~~#Consider adding a nasal cannula increased >10L/min or as tolerated by patient along with nonrebreather mask~~

	*Positive pressure ventilation ~~should be given to~~ patients unable to achieve oxygen saturations of >93 – 95% with 3 minutes of high FiO<sub>2</sub>		:Consider adding a nasal cannula increased >10L/min or as tolerated by patient along with nonrebreather mask
	*~~Positive pressure ventilation should be given to~~ patients already apneic due to respiratory failure
			*'''Positive pressure ventilation:'''
			**In patients unable to achieve oxygen saturations of >93 – 95% with 3 minutes of high FiO<sub>2</sub>
			*In patients already apneic due to respiratory failure

	====Patient Positioning====		====Patient Positioning====

Ostermayer: /* Preoxygenation Times: */

2014-04-05T22:33:10Z

Preoxygenation Times:

← Older revision		Revision as of 22:33, 5 April 2014
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	====Preoxygenation Times:====		====Preoxygenation Times:====
	#3 minutes of tidal volume breathing with a high FiO2 source (15L nasal cannula + 100% non rebreather on patient at the same time)		3 minutes of tidal volume breathing with a high FiO2 source (15L nasal cannula + 100% non rebreather on patient at the same time)
	OR		OR
	#8 vital capacity breaths (maximal inhalation and maximal exhalation) with a high FiO2 source		8 vital capacity breaths (maximal inhalation and maximal exhalation) with a high FiO2 source

	====Oxygen Sources for Preoxygenation:====		====Oxygen Sources for Preoxygenation:====

Ostermayer: /* Patient Positioning */

2014-04-05T22:32:47Z

Patient Positioning

← Older revision		Revision as of 22:32, 5 April 2014
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	{\|class="wikitable"		{\|class="wikitable"
	\|+Comparison of patient head up positioning		\|+Comparison of patient head up positioning
	\| 20° head-up\|\|386 ~~seconds~~ vs 283 seconds to desaturate<ref>Lane S, Saunders D, Schofield A, et al. A prospective, randomised controlled trial comparing the efficacy of pre- oxygenation in the 20 degrees head-up vs supine position. Anaesthesia. 2005;60:1064-1067</ref>		\| 20° head-up\|\|386 vs 283 seconds to desaturate<ref>Lane S, Saunders D, Schofield A, et al. A prospective, randomised controlled trial comparing the efficacy of pre- oxygenation in the 20 degrees head-up vs supine position. Anaesthesia. 2005;60:1064-1067</ref>
	\|-		\|-
	\| 20° head-up\|\|452 ~~seconds~~ vs 364 seconds to desaturate<ref>Ramkumar V, Umesh G, Philip FA. Preoxygenation with 20° head- up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. J Anesth. 2011;25:189-194</ref>		\| 20° head-up\|\|452 vs 364 seconds to desaturate<ref>Ramkumar V, Umesh G, Philip FA. Preoxygenation with 20° head- up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. J Anesth. 2011;25:189-194</ref>
	\|-		\|-
	\| 25° head-up for BMI > 40\|\|214 ~~seconds~~ vs 162 seconds to desaturate <ref>Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005;102:1110-1115; discussion 1115A</ref>		\| 25° head-up for BMI > 40\|\|214 vs 162 seconds to desaturate <ref>Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005;102:1110-1115; discussion 1115A</ref>

	\|}		\|}