While there are different ways of providing ApOx, the most common and cheapest is to use a nasal cannula with oxygen up to the maximum flow (providing more than 50 L/min). High-flow nasal cannula or positive-pressure ventilation provide preoxygenation, but they are less available and more expensive.

What all ApOx techniques have in common is that there is a focus on better peri-intubation techniques and better preoxygenation. ApOx in adult patients requiring emergency intubation is a low-cost, universally available technique that can reduce the incidence of hypoxemia and increase first-pass intubation rates. No adverse effects have been reported.

This topic has also been nicely discussed by:

• Salim Rezaie, MD, on Rebel EM.
• Rory Spiegel, MD, on EMNerd.
• John C. Sakles, MD, in the editorial “Maintenance of oxygenation during rapid sequence intubation in the emergency department.”⁷

Dr. Levitan is an adjunct professor of emergency medicine at Dartmouth College’s Geisel School of Medicine in Hanover, New Hampshire.

Dr. Bellolio is an emergency physician at the Mayo Clinic in Rochester, Minnesota.

References

1. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165-175.e1.
2. Denton G, Howard L. BET 1: Does apnoeic oxygenation reduce the risk of desaturation in patients requiring endotracheal intubation? Emerg Med J. 2016;33(7):517-519.
3. Silva LOJE, Cabrera D, Barrionuevo P, et al. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Ann Emerg Med. 2017;70(4):483-494.e11.
4. Pavlov I, Medrano S, Weingart S. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: a systematic review and meta-analysis. Am J Emerg Med. 2017;35(8):1184-1189.
5. Binks MJ, Holyoak RS, Melhuish TM, et al. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis [published online ahead of print June 24, 2017]. Am J Emerg Med.
6. Caputo N, Azan B, Domingues R, et al. Emergency department use of apneic oxygenation versus usual care during rapid sequence intubation: a randomized controlled trial (The ENDAO Trial) [published online ahead of print Aug. 9, 2017]. Acad Emerg Med.
7. Sakles JC. Maintenance of oxygenation during rapid sequence intubation in the emergency department [published online ahead of print Aug. 9, 2017]. Acad Emerg Med.