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• W2890213425 abstract "The adequacy of preoxygenation of patients undergoing rapid sequence intubation (RSI) in the emergency department (ED) is performed to reduce the risk of hypoxemia during intubation and to prolong the safe apneic period. Recent studies in healthy volunteers have shown that FeO2 monitoring can be useful to determine the adequacy of various ED preoxygenation methods. No study has assessed the correlation between FeO2 values obtained during preoxygenation to predict the PaO2 in critically-ill patients undergoing RSI in the ED. Our objective was to determine whether a novel equation using the FeO2 at the end of preoxygenation could reliably estimate the PaO2 in critically ill ED patients undergoing RSI. We conducted a prospective observational study performed at an adult academic level 1 trauma center utilizing a gas analyzer to obtain continuous FeO2 and FiO2 values among all patients undergoing RSI in the ED. We excluded patients in cardiac or traumatic arrest. We used the following equation to estimate the minimal PaO2 at the end of the preoxygenation period of RSI: FeO2 X critical coefficient (CC) X 7.6 X FiO2. The CC was determined based upon the American Society of Anesthesiologists physical status classification system (ASA) as a surrogate measure of the respiratory coefficient used in the alveolar gas equation. The CC, FeO2, and FiO2 measurements were documented by ED providers not directly involved in the procedure and were blinded to our study's hypothesis using a standardized data collection form. The intubating operators were also blinded to these measurements. We calculated the Pearson's correlation coefficient between the novel equation's predicted minimal PaO2 and the PaO2 drawn from an ABG within 3 minutes after intubation. Seventy patients were enrolled. The equation's mean predicted PaO2 versus PaO2 from the post-intubation ABG was 178 mmHg (95% CI 145 - 211) and 209 mmHg (95% CI 170 - 258), respectively. The absolute difference between the equation's predicted PaO2 and ABG PaO2 was 31 mmHg (95% CI -18 - 80; p=0.22). The Pearson's correlation coefficient between the predicted PaO2 and ABG PaO2 demonstrated a strong correlation (r2=0.89). Among patients undergoing RSI in the ED, the use of a gas analyzer measuring the FeO2 and FiO2 during the peri-intubation period can provide a reliable measure of the minimal PaO2 after preoxygenation when combined with the ASA classification via the use of our novel equation. Bedside gas analysis monitoring during ED RSI can be used to help determine the adequacy of preoxygenation and period of safe apnea time in order to prevent desaturation during intubation." @default.
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• W2890213425 date "2018-10-01" @default.
• W2890213425 modified "2023-09-27" @default.
• W2890213425 title "131 Fraction of Expired Oxygen Can Reliably Predict the Arterial Partial Pressure of Oxygen Among Emergency Department Patients Undergoing Rapid Sequence Intubation" @default.
• W2890213425 doi "https://doi.org/10.1016/j.annemergmed.2018.08.136" @default.
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