Research
Print page Print page
Switch language
Rigshospitalet - a part of Copenhagen University Hospital
E-pub ahead of print

Exploring the limits of prolonged apnoea with high-flow nasal oxygen: an observational study

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. From variance to guidance for awake tracheal intubation

    Research output: Contribution to journalEditorialResearchpeer-review

  2. Red blood cell transfusion in surgery: an observational study of the trends in the USA from 2011 to 2016

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Challenges in optimising recovery after emergency laparotomy

    Research output: Contribution to journalReviewResearchpeer-review

  4. Variation in the practice of tracheal intubation in Europe after traumatic brain injury: a prospective cohort study

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Enhanced postoperative recovery: good from afar, but far from good?

    Research output: Contribution to journalReviewResearchpeer-review

  1. Anesthesiologists’ airway management expertise: Identifying subjective and objective knowledge gaps

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. A marking of the cricothyroid membrane with extended neck returns to correct position after neck manipulation and repositioning

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Blood pressure and brain injury in cardiac surgery: a secondary analysis of a randomized trial

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

High-flow nasal oxygen is increasingly used for oxygenation during apnoea. Extending apnoea duration using this technique has mainly been investigated during minor laryngeal surgery, but it is unclear how long it can be administered for before it should be discontinued due to acidosis. We aimed to describe the dynamics of arterial blood gases during apnoeic oxygenation with high-flow nasal oxygen with jaw thrust only, to explore the limits of this technique. We included adult orthopaedic patients scheduled for general anaesthesia. After pre-oxygenation, anaesthesia with neuromuscular blockade was induced and high-flow nasal oxygen (70 l.min-1 ) was continued with jaw thrust as the only means of airway management, with monitoring of vital signs and arterial blood gas sampling every 5 minutes. Apnoeic oxygenation with high-flow nasal oxygen was discontinued when arterial carbon dioxide tension (PaCO2 ) exceeded 12 kPa or pH fell to 7.15. This technique was used in 35 patients and median (IQR [range]) apnoea time was 25 (20-30 [20-45]) min and was discontinued in all patients when pH fell to 7.15. The mean (SD) PaCO2 increase was 0.25 (0.06) kPa.min-1 but it varied substantially (range 0.13-0.35 kPa.min-1 ). Mean (SD) arterial oxygen tension was 48.6 (11.8) kPa when high-flow nasal oxygen was stopped. Patients with apnoea time > 25 minutes were significantly older (p = 0.025). We conclude that apnoeic oxygenation with high-flow nasal oxygen resulted in a significant respiratory acidosis that varies substantially on the individual level, but oxygenation was maintained.

Original languageEnglish
JournalAnaesthesia
ISSN0003-2409
DOIs
Publication statusE-pub ahead of print - 11 Nov 2020

ID: 61227287