Nasal high-flow preoxygenation for endotracheal intubation in the critically ill patient? Con

Excerpt

In 1959, Weitzner et al. published a cornerstone clinical study addressing the issue of arterial desaturation during apnoea following induction of general anaesthesia [1]. They showed that face-mask ventilation with 100% inhaled oxygen (O₂) before apnoea enabled the maintaining of arterial oxygen saturation up to 4 min in contrast to less than 1 min following ventilation with air. In 2019, preoxygenation is recommended for all patients before induction of anaesthesia and endotracheal intubation, and the end point of maximal preoxygenation is defined as an end tidal oxygen concentration (ETO₂) ≥ 90% [2]. Preoxygenation remains an area of research because hypoxaemia during upper airway management is still a concern in the operating room [2] and much more so in the intensive care unit where severe hypoxaemia and cardiac arrest have been reported to occur in 26% and 2.7%, respectively, during orotracheal intubation of adult critically ill patients [3, 4]. Furthermore, technological progress in anaesthesia machines, intensive care units ventilators, and oxygenation devices could improve the efficacy of preoxygenation and must be evaluated. …