Best Method to Reduce Hypoxemia

During Endotracheal Intubation

Intubation and Periprocedural Complications
Preoxygenation
Standard vs. Advanced Preoxygenation Practices
Preoxygenation with BiPAP reduces shunt physiology and
improves oxygenation by increasing alveolus surface area.
References

Bradley King, RRT-ACCS

Intubation and Periprocedural

Complications
Hypoxemia is the most commonly reported procedural complication
observed during intubation (De Jong, et al., 2013).
Hypoxemia simply means low oxygen levels in the blood.
Occurs when PaO2 < 60 mmHg or SpO2 < 90%.
Commonly caused by physiologic shunt.
Oxygen saturation < 70% can cause dysrhythmia, hemodynamic
decompensation, hypoxic brain injury, and death (Weingart & Richard,
2012).

Preoxygenation
Temporarily increasing the PaO2 and SaO2 prior to intubation,
extending the period of safe apnea.
Lowers the risk of severe complications associated with hypoxemia.
The goal is to achieve an SpO2 of 100% before proceeding with
intubation.
Obeys Ficks law of diffusion.

Standard vs. Advanced Preoxygenation

Standard

Advanced

Non-rebreather mask
Delivers 60-80% FiO2
Will not improve oxygenation in the
presence of physiologic shunt.

Bi-level positive airway pressure (BiPAP)

Delivers 100% FiO2.
Improves oxygenation in the presence of
physiologic shunt with PEEP.

Study

Patients

Intervention

Outcome

Baillard et al.

N= 53

N= 26 received standard
preoxygenation.

Po2 with BiPAP compared

to standard preoxygenation.

N=27 received advanced

preoxygenation.
(Antonell, et al., 2002)

N= 26

N= 13 received standard
oxygenation via venture
mask
N= 13 received BIPAP

BIPAP was superior in

terms of preventing
hypoxemia prior to
intubation.

Preoxygenation with BiPAP reduces shunt physiology

and improves oxygenation by increasing alveolus
surface area.

(Arcos,
2011)

References
Antonell, M., Conti, G., Rocco, M., Arcangeli, A., Cavaliere, F., Proietti, R., & Meduri, G. U.
(2002). Noninvasive Positive-Pressure Ventilation vs Conventional Oxygen Supplementation in
Hypoxemic Patients Undergoing Diagnostic Bronchoscopy. Chest, 121(4), 1149-1153.
Arcos, M. (Producer). (2011). Incremental PEEP Trial [Motion Picture]. YouTube.
Baillard, C., Fosse, J.-P., Sebbane, M., Chanques, G., Vincent, F., Courouble, P., . . . Jabe, S.
(2006). Noninvasive Ventilation Improves Preoxygenation before Intubation of Hypoxic Patients .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE,
174, 171177.
De Jong, A., Molinar, N., Terzi, N., Mongardon, N., Arnal, J.-M., Guitton, C., . . . Jaber, S. (2013,
April 15). Early Identification of Patients at Risk for Difficult Intubation in the Intensive Care
Unit. American Journal of Respiratory and Critical Care Medicine, 187(8), 832-839.
Weingart, S. D., & Richard, L. M. (2012, March). Preoxygenation and Prevention of Desaturation
During Emergency Airway Management . Annals of Emergency Medicine, 59(3), 165-175.