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Friday, September 9, 2022

HFNC vs NC for RSI

REBEL Cast Ep112 - By Salim Rezaie - September 08, 2022

Paper: Chua MT et al. Pre- and Apnoeic High-Flow Oxygenation for Rapid Sequence Intubation in the Emergency Department (the Pre-AeRATE Trial): A Multicentre Randomised Controlled Trial. Ann Acad Med Singap 2022. PMID: 35373238 [Access on Read by QxMD]
Clinical Question: Does HFNC oxygenation for preoxygenation and apnoeic oxygenation maintain a higher oxygen saturation (SpO2) during RSI in ED patients compared to usual care (Nasal Cannula)?
Author Conclusion: “Use of HFNC for preoxygenation and apnoeic oxygenation when compared to usual care, did not improve lowest SpO2 during the first intubation attempt but may prolong safe apnoea time.”
Clinical Take Home Point: I am not surprised by these results. In a population of predominantly neurologic emergencies, HFNC used for preoxygenation and apneic oxygenation did not show improvement in median lowest SpO2 achieved during the 1st intubation attempt. However, HFNC did seem to prolong safe apnea (≈3min) and decrease the risk of SpO2 falling below 90% compared to NRB + NC. HFNC could be considered as an intermediary step for patients in cardiopulmonary extremis or with perceived difficult airways when not tolerating NIV.