scholarly journals Randomised controlled trial to assess the effectiveness of apnoeic oxygenation in adults using low-flow or high-flow nasal cannula with head side elevation versus usual care to prevent desaturation during endotracheal intubation in the emergency department (ApOxED): study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037964
Author(s):  
Shahan Waheed ◽  
Nazir Najeeb Kapadia ◽  
Muhammad Faisal Khan ◽  
Salima Mansoor Kerai ◽  
Ahmed Raheem ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Oxygen Delivery ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
Usual Practice ◽  
High Flow Oxygen ◽  
Randomised Controlled ◽  
Apnoeic Oxygenation

IntroductionApnoeic oxygenation is a process of delivering continuous oxygen through nasal cannula during direct laryngoscopy. The oxygen that is delivered through these nasal cannulas is either low flow or high flow. Although the effectiveness of apnoeic oxygenation has been shown through systematic reviews and randomised controlled trials, a comparison of high-flow versus low-flow oxygen delivery has not been tested through a superiority study design. In this study we propose to assess the effectiveness of giving low-flow oxygen with head side elevation versus high-flow oxygen with head side elevation against the usual practice of care in which no oxygen is provided during direct laryngoscopy.Methods and analysisThis will be a three-arm study instituting a block randomisation technique with a sample size of 46 in each arm (see table 1). Due to the nature of the intervention, no blinding will be introduced. The primary outcomes will be lowest non-invasive oxygen saturation measurement during direct laryngoscopy and during the 2 min after the placement of the tube and the first pass success rate. The intervention constitutes head side elevation up to 30° for improving glottis visualisation together with low-flow or high-flow oxygen delivery through nasal cannula to increase safe apnoea time for participants undergoing endotracheal intubation. Primary analysis will be intention to treat.Ethics and disseminationThe study is approved by the Ethical Review Committee of Aga Khan University Hospital (2019-0726-2463). The project is an institution University Research Committee grant recipient 192 002ER-PK. The results of the study will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations and emails. Further, the findings will be published in a highly accessed peer-reviewed medical journal and will be presented at both national and international conferences.Trial registration numberClinicalTrials.gov Registry (NCT04242537).

High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial

The Lancet ◽  
2017 ◽  
Vol 389 (10072) ◽  
pp. 930-939 ◽  
Author(s):  
Elizabeth Kepreotes ◽  
Bruce Whitehead ◽  
John Attia ◽  
Christopher Oldmeadow ◽  
Adam Collison ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
Open Phase ◽  
Randomised Controlled

scholarly journals High-flow oxygen nasal cannula for treating acute bronchiolitis in infants: A systematic review and meta-analysis

Medwave ◽  
2021 ◽  
Vol 21 (04) ◽  
pp. e8190-e8190
Author(s):  
Fernando Tortosa ◽  
Ariel Izcovich ◽  
Gabriela Carrasco ◽  
Gabriela Varone ◽  
Pedro Haluska ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Treatment Failure ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
Acute Bronchiolitis ◽  
High Flow Oxygen ◽  
Flow Group

Introduction Oxygen therapy through a high-flow nasal cannula is thought to improve the work of breathing and the comfort of patients with acute bronchiolitis. It is widely used in hospital wards and critical care of pediatric patients. However, there is uncertainty on the magnitude of the effect on critical and important outcomes in these patients. Objectives The objective of this review is to evaluate the available evidence on the use of oxygen administered through high-flow cannula versus low-flow oxygen for the treatment of acute bronchiolitis in children under two years of age. Methodology We carried out a systematic review and a meta-analysis following the PRISMA standards for reporting. The search was carried out in electronic databases by two researchers independently. The evidence was summarized using the GRADE methodology. Results Six randomized and non-randomized clinical trials were included, including 1867 individuals younger than 24 months of age with acute bronchiolitis in pediatric emergency, hospitalization, and intensive care services. Mortality was not reported in the included studies. Treatment failure occurred in 108/933 in the high flow group and 233/934 in the low flow group (relative risk: 0.46; 95% confidence interval: 0.35 to 0.62), which shows 11.7% less treatment failure (95% confidence interval between 7.9% and 14.5% less) in the high flow group with a number needed to treat of 7.5 (95% confidence interval 6 to 10) with moderate certainty in the evidence. Conclusion The use of humidified and heated oxygen with high flow compared to oxygen at low flow is probably associated with decreased treatment failure in children younger than two years with acute bronchiolitis. There is uncertainty about the effect on hospitalization days and clinical progression.

Using a high-flow nasal cannula provided superior results to low-flow oxygen delivery in moderate to severe bronchiolitis

2016 ◽  
Vol 105 (8) ◽  
pp. e368-e372 ◽  
Author(s):  
Gregorio P. Milani ◽  
Anna M. Plebani ◽  
Elisa Arturi ◽  
Danila Brusa ◽  
Susanna Esposito ◽  
...  
Keyword(s):  
Oxygen Delivery ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
High Flow Nasal Cannula

scholarly journals Oxygenation laryngoscope vs. nasal standard and nasal high flow oxygenation in a technical simulation of apnoeic oxygenation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
H. Herff ◽  
W. A. Wetsch ◽  
S. Finke ◽  
F. Dusse ◽  
T. Mitterlechner ◽  
...  
Keyword(s):  
Airway Management ◽  
Oxygen Concentration ◽  
High Flow ◽  
Nasal Cannula ◽  
Pure Oxygen ◽  
High Flow Oxygen ◽  
Failed Airway ◽  
Oxygen Group ◽  
And Control ◽  
Apnoeic Oxygenation

Abstract Background Failed airway management is the major contributor for anaesthesia-related morbidity and mortality. Cannot-intubate-cannot-ventilate scenarios are the most critical emergency in airway management, and belong to the worst imaginable scenarios in an anaesthetist’s life. In such situations, apnoeic oxygenation might be useful to avoid hypoxaemia. Anaesthesia guidelines recommend careful preoxygenation and application of high flow oxygen in difficult intubation scenarios to prevent episodes of deoxygenation. In this study, we evaluated the decrease in oxygen concentration in a model when using different strategies of oxygenation: using a special oxygenation laryngoscope, nasal oxygen, nasal high flow oxygen, and control. Methods In this experimental study we compared no oxygen application as a control, standard pure oxygen application of 10 l·min− 1 via nasal cannula, high flow 90% oxygen application at 20 l·min− 1 using a special nasal high flow device, and pure oxygen application via our oxygenation laryngoscope at 10 l·min− 1. We preoxygenated a simulation lung to 97% oxygen concentration and connected this to the trachea of a manikin model simulating apnoeic oxygenation. Decrease in oxygen concentration in the simulation lung was measured continuously for 20 min. Results Oxygen concentration in the simulation lung dropped from 97 ± 1% at baseline to 40 ± 1% in the no oxygen group, to 80 ± 1% in the standard nasal oxygen group, and to 73 ± 2% in the high flow nasal oxygenation group. However, it remained at 96 ± 0% in the oxygenation laryngoscope group (p < 0.001 between all groups). Conclusions In this technical simulation, oxygenation via oxygenation laryngoscope was more effective than standard oxygen insufflation via nasal cannula, which was more effective than nasal high flow insufflation of 90% oxygen.

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