VAPOX and Vent-as-Bag
In a concept piece called Preoxygenation. Reoxygenation and Delayed Sequence Intubation in the Emergency Department, I outlined a concept which I called: the vent as a bag. Why would we use the unpredictable and unmeasured BVM, when instead we could use a purpose-built, strictly internally regulated machine like a ventilator. I had stopped talking about the idea when numerous people told me it was unfeasible in their environment–however, I continued this practice for my own patients throughout my practice.
Recently, Grant et al. published a case series using the same concept–they have dubbed their vision of it VAPOX.
Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator (DOI: 10.1111/1742-6723.12524)[cite source='doi']10.1111/1742-6723.12524[/cite]
their protocol is very similar to the one I have used:
- Respiratory rate of 6–8 breaths per minute
- Pressure support 0 cm water (I never bothered unless pt had severe acidosis–the authors used PS of 10)
- Positive end expiratory pressure starting at 5 cm water (titrate up to 15 if not getting sats > 95% in preox)
- Fraction inspired oxygen 1.0
- Vt 550 ml
- Inspiratory Flow (30 lpm)
See Grant et al.'s paper for their protocol
Also consider getting some mask straps
And Remember the Nasal Cannula at 15 lpm
See the EMCrit Preoxygenation Page
Now on to the Podcast…