Apneic Oxygenation Prevents Desaturation During Intubation

Authors: Binks MJ et al.

Am J Emerg Med 2017 Jun 24;

Two meta-analyses used different methods but have similar findings.

Apneic oxygenation is the delivery of high-flow oxygen by nasal cannula during endotracheal intubation. Two separate meta-analyses provide pooled results from trials of apneic oxygenation.

The first meta-analysis included 8 studies and 1953 patients in critical care settings. It found that the risk for “clinically significant hypoxemia” (reduction of oxygen saturation to <90%–93%) was 28% in the usual care group and 19% in the apneic oxygenation group — a reduction of 30% — without any heterogeneity in outcome across studies.

The second meta-analysis included 6 studies and 1822 patients in prehospital and emergency department settings. It found that the risk for “critical desaturation” (reduction of oxygen saturation to <80%) was halved (relative risk, 0.51) with apneic oxygenation in the three studies that used this outcome. The risk of desaturation to below 93%–95% was reduced by 24% (RR, 0.76) in the five studies that used this outcome. There was substantial heterogeneity in this outcome among studies.