Pre oxygenation in the ICU

[bkell101]

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Was on a website emcrit and came across two articles

http://download.journals.elsevierhealth.com/pdfs/journals/0196-0644/PIIS0196064411016672.pdf

http://ec.libsyn.com/p/f/2/e/f2ed6a...1ce3dae902ea1d01ce8630d3c158570f&c_id=2523611

What are your thoughts on NIV for pre oxygenation?

What steps do you routinely take to preoxygenate the pt with sats 90-91 on 15L non rebreather? (Evidence of pneumonia, not hypotensive)

Also, thank you very much to those of you who have helped clarify some of the other questions I've posted.

 

[dotcb]

I routinely use nasal cannula for apneic oxygenation with patients who at high risk for desaturation. My experience is that it delays desaturation. I have used ketamine and NIV to preoxygenate patients, and have occasionally been able to avoid intubating them altogether (asthma). If the patient is not tolerating the preoxygenation and could stand being hypertensive and tachycardic, I frequently will give ketamine as induction just to take control of the situation. It usually gives a few minutes of a more passive patient for better preoxygenation and better preparation to intubate in a more controlled fashion.