Non-invasive positive pressure ventilation (NIPPV)

Advantages:

• Tight fitting mask allows for near 100% Fio2 delivery
• Positive pressure may open up atelectatic areas of the lung, increasing the amount of airspace available to store oxygen and decreasing shunting
• May be especially helpful in the morbidly obese and pts with obstructive lung disease

Several small anesthesia studies have demonstrated major benefit in prolonging time to critical desaturation by ~100-120 seconds on average

Flush Rate Non-Rebreather Mask

Achieved by turning the standard wall mounted O2 flowmeter all the way open to achieve flow rates in the 50-60 liters per minute range

 Advantages

• Flush rate oxygen provides a higher FiO2 than a standard non-rebreather at 15 lpm
• It's free and safe

A study on healthy volunteers measuring % of expired oxygen after pre-oxygenation found flush rate O2 (86%) to be superior to both standard non-rebreather (54%) and a bag-valve mask with a PEEP valve (77%)

Conclusion:

 Use flush rate non-breather or NIPPV for preoxygenation in your patients to prolong time to desaturation during intubation

Ref:

Driver BE, Prekker ME, Komas RL, Cales EK, Reardon RF. Flush Rate Oxygen for Emergency Airway Preoxygenation. Annals of Emergency Medicine 2017; 69(1): 1-6

Sreejit MS and Ramkumar V. Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea. Indian Journal of Anaesthesia 2015; 59(4): 216-221

Herriger A, Frascarolo Ph., Spahn DR, and Magnusson L. The effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon duration of non-hypoxic apnoea. Anaesthesia 2004; 59: 243-7