You know that I obsess over the physiologically difficult airway–well there turns out to be an ED Crit Care doc who is equally as obsessive–Jarrod Mosier. Today, we talk about the hypoxemic physiologically difficult airway and many things preox!
Jarrod Mosier, MD FCCM
Associate Professor, Emergency Medicine
Associate Professor, Medicine
Associate Program Director, Critical Care Fellowship
Medical Director, Adult ECMO (Extracorporeal Membrane Oxygenation) Service
University of Arizona College of Medicine
Low to Moderate Risk of Desaturation
Moderate to High Risk of Desaturation
High to Refractory Risk of Hypoxemia
Moody Teenager Lung
#### Mosier JM Br J Anaesth 2020;125(1):e1
far right of the bell curve of risk of desaturation
- Need a reasonable FRC
- full oxygenation of that FRC
- That volume connected to the alveolar vessels -to be transmitted to the bloodstream
Tanoubi et al. estimation of safe apnea time formula
Why doesn't apox work
it is shunt fraction and its syngergistic partner low SvO2
Need a lot more PEEP when transitioning from NPV to PPV
PEEP is maint. in addition to recruitment
Pendelluft Phenomena movement of gas from recruited lung to non-recruited causing lung injury
he also postulates an abrupt increase in r sided heart pressures made even worse by bagging
Does 100% precipitate absorption atelectasis--no! put in the article from crashing patient
#### Mosier et al. WestJem 2015;16(7):1109
added R sided failure to the HOP killers
#### Mosier et al. Intens Care Med 2017;43:226
in the lungs PaO2 creates the sat in the blood, the sat creates the PaO2
Dr. Mosier's Relevant Publications
Kornas, Rebecca L., Clark G. Owyang, John C. Sakles, Lorraine J. Foley, and Jarrod M. Mosier. “Evaluation and Management of the Physiologically Difficult Airway: Consensus Recommendations From Society for Airway Management.” Anesthesia & Analgesia Publish Ahead of Print (October 14, 2020). https://doi.org/10.1213/ANE.0000000000005233.
Mosier, Jarrod, Raj Joshi, Cameron Hypes, Garrett Pacheco, Terence Valenzuela, and John Sakles. “The Physiologically Difficult Airway.” Western Journal of Emergency Medicine 16, no. 7 (December 17, 2015): 1109–17. https://doi.org/10.5811/westjem.2015.8.27467.
Mosier, Jarrod M. “Physiologically Difficult Airway in Critically Ill Patients: Winning the Race between Haemoglobin Desaturation and Tracheal Intubation.” British Journal of Anaesthesia 125, no. 1 (July 2020): e1–4. https://doi.org/10.1016/j.bja.2019.12.001.
Mosier, Jarrod M., and Cameron D. Hypes. “Mechanical Ventilation Strategies for the Patient with Severe Obstructive Lung Disease.” Emergency Medicine Clinics of North America 37, no. 3 (August 2019): 445–58. https://doi.org/10.1016/j.emc.2019.04.003.
Mosier, Jarrod M., Cameron D. Hypes, and John C. Sakles. “Understanding Preoxygenation and Apneic Oxygenation during Intubation in the Critically Ill.” Intensive Care Medicine 43, no. 2 (February 2017): 226–28. https://doi.org/10.1007/s00134-016-4426-0.
Sakles, John, Cassidy Augustinovich, Asad Patanwala, Garrett Pacheco, and Jarrod Mosier. “Improvement in the Safety of Rapid Sequence Intubation in the Emergency Department with the Use of an Airway Continuous Quality Improvement Program.” Western Journal of Emergency Medicine 20, no. 4 (June 3, 2019): 610–18. https://doi.org/10.5811/westjem.2019.4.42343.