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doi: https://doi.org/10.15441/ceem.23.089    [Accepted]
Preoxygenation and apneic oxygenation in emergency airway management
Alexandra Barbosa1 , Jarrod M. Mosier1,2
1Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
2Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
Correspondence  Alexandra Barbosa Email: abarbosa@aemrc.arizona.edu
Received: July 12, 2023. Revised: November 11, 2023.  Accepted: November 12, 2023. Published online: January 29, 2024.
Preoxygenation during the peri-intubation period is now considered a critical aspect of rapid sequence intubation and an important skill for emergency medicine and critical care providers. Peri-intubation hypoxemia carries significant risk, including cardiac arrest, and care must be taken for appropriate management including through apnea and initiation of laryngoscopy. Appropriate selection of preoxygenation devices should depend on underlying physiology to optimize oxygenation prior to intubation attempts. A PubMed MEDLINE search was completed with selection of articles from March 2008 to March 2023 describing various techniques for preoxygenation for intubation in the critical care and operating room setting with pregnant and obese patient populations included. Prehospital and pediatric populations were excluded in this review. This review provides an overview of methods of preoxygenation with their clinical indications as well as methods for determining end points to preoxygenation and apneic oxygenation. An overview of approaches to preoxygenation was included for patients considered to have a physiologically difficult airway and obese and pregnant patient populations.
Keywords: Preoxygenation; Intubation; Rapid sequence intubation
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