Abstract | INTRODUCTION: Endotracheal intubation in critically ill patients is associated with severe life-threatening complications in about 20%, mainly due to hypoxemia. We hypothesized that apneic oxygenation via a pharyngeal catheter during the endotracheal intubation procedure would prevent or increase the time to life-threatening hypoxemia and tested this hypothesis in an acute lung injury animal model. METHODS: Eight anesthetized piglets with collapse-prone lungs induced by lung lavage were ventilated with a fraction of inspired oxygen of 1.0 and a positive end-expiratory pressure of 5 cmH2O. The shunt fraction was calculated after obtaining arterial and mixed venous blood gases. The trachea was extubated, and in randomized order each animal received either 10 L oxygen per minute or no oxygen via a pharyngeal catheter, and the time to desaturation to pulse oximeter saturation (SpO2) 60% was measured. If SpO2 was maintained at over 60%, the experiment ended when 10 minutes had elapsed. RESULTS: Without pharyngeal oxygen, the animals desaturated after 103 (88-111) seconds (median and interquartile range), whereas with pharyngeal oxygen five animals had a SpO2 > 60% for the 10-minute experimental period, one animal desaturated after 7 minutes, and two animals desaturated within 90 seconds (P < 0.016, Wilcoxon signed rank test). The time to desaturation was related to shunt fraction (R2 = 0.81, P = 0.002, linear regression); the animals that desaturated within 90 seconds had shunt fractions >40%, whereas the others had shunt fractions <25%. CONCLUSIONS:
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Authors | Joakim Engström, Göran Hedenstierna, Anders Larsson |
Journal | Critical care (London, England)
(Crit Care)
Vol. 14
Issue 3
Pg. R93
( 2010)
ISSN: 1466-609X [Electronic] England |
PMID | 20497538
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Acute Lung Injury
(physiopathology, therapy)
- Animals
- Bronchoalveolar Lavage
- Carbon Dioxide
(blood)
- Catheterization, Peripheral
- Hemodynamics
- Hydrogen-Ion Concentration
- Hypoxia
(prevention & control)
- Intubation, Intratracheal
- Oxygen
(administration & dosage)
- Pharynx
- Positive-Pressure Respiration
- Sweden
- Swine
- Treatment Outcome
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