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The following is a summary of “End-Tidal Oxygen as an Effective Noninvasive Measure of Preoxygenation during Rapid Sequence Intubation in the Emergency Department,” published in the January 2025 issue of Emergency Medicine by Boccio et al.
Preoxygenation aimed to prolong apnea duration until desaturation, with end-tidal oxygen (ETO2) being the standard measure, although peripheral capillary oxygen saturation (SpO2) was more frequently used in emergency departments.
Researchers conducted a retrospective study to examine whether patients were optimally preoxygenated as measured by ETO2 vs SpO2 during rapid sequence intubation and to evaluate changes in the measurements and the impact of patient characteristics on preoxygenation success.
They performed a study involving a convenience sample of patients undergoing rapid sequence intubation. ETO2 and SpO2 measurements were recorded at the end of preoxygenation (T1) and following intubation completion (T2). Optimal preoxygenation was defined by an ETO2 level of ≥ 90% and a SpO2 level of 100% at T2.
The results showed 30 patients were included in the analysis. Median ETO2 and SpO2 at T1 were 90.5% (interquartile range 86–93%) and 100% (interquartile range 97–100%), respectively. Preoxygenation success rates were 56.7% for ETO2 and 53.3% for SpO22 (P = 0.431). The mean (SD) decreases in ETO2 during intubation was more significant and variable compared to SpO2 (25.8% [22.5%] vs 2.1% [3.3%]; P < 0.001). Patient age, sex, and body mass index did not correlate with preoxygenation success for either modality.
Investigators concluded the preoxygenation success appeared similar when measured by end-tidal oxygen and peripheral oxygen saturation, end-tidal oxygen might be a more sensitive indicator of impending desaturation during apnea compared to peripheral oxygen saturation.
Source: sciencedirect.com/science/article/abs/pii/S0736467924002300
