![]() non-rebreather (NRB) mask and a good seal at 15 L/min O2 or more.bag-valve-mask (BVM) with PEEP valve and a good seal at 15+ L/min O2 or more, or.Choose preoxygenation device based on the patient’s SpO2:.Place standard nasal cannula (at 15 L/min oxygen) prior to placement of the preoxygenation device if apnoeic oxygenation will be used once the patient is sedated (also serves as a preoxygenation adjunct).this increases functional residual capacity and thus the oxygen reservoir of the lungs.Position the patient ‘head up’ at 30 degrees (or more), with auditory meatus above the jugular notch.Perform standard monitoring for emergency intubation.Outside of the operating theatre, this approach is effective for preoxygenation: see apnoeic oxygenation and delayed sequence intubation.Apnoeic oxygenation is merely an adjunct, it cannot compensate for ineffective preoxygenation.Airway patency must be maintained throughout preoxygenation and apnoeic oxygenation.In some cases, instead of apnoeic oxygenation, the benefits of ongoing ventilation to avoid apnoea and hypoxia may outweigh the risk of aspiration.in critical care settings apnoeic oxygenation is most commonly with 15L/min via nasal prongs. ![]() Oxygenation can be further optimised by performing apnoeic oxygenation in addition to preoxygenation.Pulmonary shunting (blood flow to the non-oxygenated, collapsed lung units) then occurs resulting in much more rapid desaturation than otherwise predicted - even if pre-oxygenation is performed.This occurs due to resorption atelectasis as oxygen transfers from the lungs into the pulmonary circulation.FRC will decrease in a healthy adult patient by about 250 mL during the first minute after airway occlusion. ![]() In patients who develop airway occlusion, desaturation will occur more rapidly due to loss of functional residual capacity (FRC) high metabolic rate, fasciculations from suxamethonium) In some critically ill patients critical desaturation may occur immediately despite attempts at preoxygenationįactors that decrease safe apnoea time include:. ![]()
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