Preoxygenation, Reoxygenation and Deoxygenation
What is this page about?
Scott Weingart, MD and Richard Levitan, MD published an article in the Annals of Emergency Medicine entitled Preoxygenation and Prevention of Desaturation during Emergency Airway Management.
This page serves as a repository for supplementary material on the subjects raised in the article.
The article is available for free on the Annals EM Site (pdf)
CPAP for Preoxygenation
In a patient with shunt, CPAP is needed for preoxygenation. In my ED, we make this happen with the ventilators installed next to every resuscitation bed.
However, not every ED has ventilators readily available and it might take >15 minutes to have respiratory bring a NIV machine or a vent. In that case, you want to use a BVM with a PEEP valve.
PEEP Valve Fits on any BVM
However, this device provides CPAP only when the patient is expiring. In a patient who is not breathing rapidly, most of the cycle will be spent at zero PEEP. Once the patient is apneic, the device won’t supply PEEP unless you manually give ventilations–even then the PEEP will only be there immediately following the ventilation. However, if you add a constant source of flow, like a nasal cannula set to 15 lpm then the BVM/PEEP Valve combo will give continuous PEEP regardless of the patients resp rate or even when they become apneic. In the following video, a PEEP valve set to 10 cm H20 provides between 6-8 cm H2) of PEEP throughout the cycle. This same nasal cannula should be on the patient anyway for apenic oxygenation and NO DESAT (Nasal Oxygen During Efforts Securing A Tube) during the intubation procedure.
Other Articles of Interest on Preoxygenation/Reoxygenation/Preventing Deoxygenation
Dr. Levitan’s site for airway videos and courses
The airwaycam site is an amazing source for educational materials and equipment to help you manage ED airways.
If you liked the article and/or this page, you’ll probably like the EMCrit Blog and Podcast…
why not check it out at emcrit.org?
Want Additional Information?
Email us on the contact page.
Hi, my name is Scott Weingart. 
{ 5 comments… read them below or add one }
This ‘poor-man’ NIPPV method (high flow NP+BVM) requires 2 Oxygen sources?
George
Clarification: This ‘poor-man’ NIPPV method (high flow Nasal Prongs+BVM/PEEP valve) requires 2 Oxygen sources?
George
In the breathing patient, which is the more effective oxygen delivery method:
1. Commercial CPAP device (Flow-safe, Boussingnac)
2. BVM with PEEP
I assume the combination BVM/PEEP with Nasal Prongs is better than above but requires 2 sources of O2.
George
Best would be commercial cpap with nasal cannula; which also requires 2 sources O2
It was nice to be able to cite (after the fact) anaesthetic literature (via your article) to an anaesthetist who tried to tell me that nasal cannula oxygenation would not be helpful during a high risk RSI.
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