Intubating the critically ill in the ICU, in theatres or in the streets is likely to be the most dangerous thing we ever do. Their physiological margins are too narrow to allow for any mucking about. Importantly, these guys won’t pre oxygenate properly, meaning you better maximise your chances of first pass success when tubing them.
We knew that. Still I found a nice old study from 2005 to emphasise it even more.
Preoxygenating the healthy patient for four minutes will often typically increase the patients PaO2 from 90 mmHg to a comfortable >400 mmHg. The study, however, took a closer look at 42 ICU patients failing non-invasive respiratory support who required intubation.
Their baseline PaO2 was on average 67 mmHg and increased to only 104 mmHg after 4 minutes of bag-mask preoxygenation. Even scarier is the fact that a third of them didn’t improve their gasses at all on preoxygenation.
Pubmed entry is here. Abstract below.