Novel Use of a Gas Analyzer Can Reliably Predict the Arterial Oxygen among Emergency Department Patients Undergoing Rapid Sequence Intubation |
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| Institution: | 1. Department of Emergency Medicine, New York Presbyterian–Columbia University, New York, New York;2. Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York;1. Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan;2. Department of Medical Imaging, Far Eastern Memorial Hospital, New Taipei, Taiwan;3. Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan;4. Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan;1. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland;2. Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon;3. York Hospital Emergency Medicine Residency Program, York, Pennsylvania;4. Johns Hopkins University, Baltimore, Maryland;6. St. John''s Regional Medical Center, Oxnard, California;5. Naval Medical Center Portsmouth, Portsmouth, Virginia;7. Department of Emergency Medicine, University of California, Irvine, California;1. Department of Medical Sciences, University of Ferrara, Ferrara, Italy;2. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy;3. Emergency Medicine, Azienda Unità Sanitaria Locale, Ferrara, Italy;4. Emergency Medicine, St. Anna Hospital, Ferrara, Italy;1. MD-PhD Program, Harvard Medical School, Boston, Massachusetts;2. Department of Emergency Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts;1. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN;2. Division of Pulmonary/Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN;3. University of Minnesota School of Medicine, Minneapolis, MN |
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| Abstract: | BackgroundTo our knowledge, no study has assessed the correlation of fraction of inspired oxygen (FiO2) and end-tidal oxygen (EtO2) values obtained from a gas analyzer during the preoxygenation period of rapid sequence intubation (RSI) to predict partial pressure of oxygen (PaO2) among patients requiring intubation in the emergency department (ED).ObjectiveThe purpose of this study was to determine whether a simple equation using EtO2 and FiO2 at time of induction could reliably estimate minimal PaO2 in ED patients undergoing RSI.MethodsWe conducted an observational pilot study performed in an adult ED utilizing a gas analyzer to obtain EtO2 and FiO2 values in ED patients undergoing RSI from data collectors blinded to our objective. The Pearson correlation coefficient was calculated between the equation's predicted PaO2 and the PaO2 drawn from an arterial blood gas shortly after intubation. A Bland-Altman plot analysis was performed to identify any additional bias.ResultsSeventy-five patients were enrolled. The equation's mean predicted minimal PaO2 and mean PaO2 from an arterial blood gas within 3 min after intubation was 178 mm Hg (95% confidence interval CI] 145–211 mm Hg) and 209 mm Hg (95% CI 170–258 mm Hg), respectively. The Pearson correlation coefficient between the predicted minimal PaO2 and post-intubation PaO2 demonstrated a strong correlation (r2 = 0.89). The Bland-Altman plot indicated no bias affecting the correlation between the predicted and actual PaO2.ConclusionsAmong ED patients undergoing RSI, the use of a gas analyzer to measure EtO2 and FiO2 can provide a reliable measure of the minimal PaO2 at the time of induction during the RSI phase of preoxygenation. |
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| Keywords: | end-tidal oxygen gas analyzer fraction of inspired oxygen arterial oxygen rapid sequence intubation |
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