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Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator
EMA - Emergency Medicine Australasia
  • Steven Grant, Gold Coast University and Robina Hospital Emergency Departments
  • Faisal Khan, Griffith University, Gold Coast, Queensland
  • Gerben Keijzers, Bond University
  • Mark Shirran, Griffith University, Gold Coast, Queensland
  • Leo Marneros, Gold Coast University and Robina Hospital Emergency Departments
Date of this Version
1-14-2016
Document Type
Journal Article
Publication Details

Citation only

Grant, S., Khan, F., Keijzers, G., Shirran, M., & Marneros, L. (2016, online first). Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator. Emergency Medicine Australasia.

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2016 HERDC submission

© Copyright, Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine, 2016

Abstract

Objective

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.

Methods

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.

Results

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%.

Conclusion

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.

Citation Information
Steven Grant, Faisal Khan, Gerben Keijzers, Mark Shirran, et al.. "Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator" EMA - Emergency Medicine Australasia (2016) ISSN: 1742-6731
Available at: http://works.bepress.com/gerben_keijzers/28/