II. Indications
- Preoxygenation in Rapid Sequence Intubation
- Carbon Monoxide Poisoning
- Severe Hypoxia temporizing measure (Oxygen Saturation <88% on FIO2 50%)
III. Precautions
- Non-Rebreather Mask will transiently improve Hypoxia despite severe lung injury or inflammation
- Severe Hypoxia is often due to physiologic shunt through diseased alveoli
- Increasing alveolar recruitment will improve both ventilation and oxygenation
- Positive Pressure Ventilation (e.g. NIPPV, Mechanical Ventilation) increases alveolar recruitment
- Contrast with Supplemental Oxygen which does NOT improve ventilation
-
Hypoxia due to apnea also improves with Supplemental Oxygen
- Apneic Oxygenation may sustain Oxygen Saturation for 30-60 minutes
- Useful in Rapid Sequence Intubation
- However, carbon dioxide will continue to rise, and pH will continue to fall without respiration
- Positive Pressure Ventilation (e.g. NIPPV, Mechanical Ventilation) is the correct treatment for apnea
- Apneic Oxygenation may sustain Oxygen Saturation for 30-60 minutes
- References
- Weingart and Swaminathan in Herbert (2021) EM:Rap 21(1): 8-9
IV. Preparations: Non-Rebreathing Mask with reservoir
- Delivers only 60-70% Oxygen at 15 L/min
- Previously described as delivering 95% FIO2 (leakage around mask prevents this)
- Standard Anesthesia masks have tighter seal and achieve closer to 95% FIO2
- Increasing flow above 15 L/min if regulator allows can achieve closer to 90% FIO2
- Alternatively concurrently apply Nasal Cannula at 15 lpm with Non-Rebreather Mask
- Two valves added to rebreathing mask prevents:
- Entrainment of room air during inspiration
- Retention of exhaled gases during expiration
V. Preparations: Oxygen Hood
- Clear plastic shell encompasses the baby's head
- Well tolerated by infants
- Size of hood limits use to younger than age 1 year
- Allows easy access to chest, trunk, and extremities
- Allows control of Oxygen Delivery
- Oxygen concentration
- Inspired oxygen Temperature and humidity
- Delivers 80-90% oxygen at 10-15 liter per minute
VI. References
- (1997) Pediatric Advanced Life Support, AHA, p. 4-5 to 4-7
- (2016) Fundamental Critical Care Support, SCCM, p. 45-60