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Improving safety of oxygen delivery

Clinical practice has often demonstrated the dangers of hypoxaemic events, so how best to handle the risks? Andi Richardson looks at how the danger can be mitigated and patient safety improved during anaesthesia.

High-flow nasal cannula (HFNC) is a humidified gas or oxygen delivery system that allows inspired oxygen (FIO2) to be delivered at very high flow rates. The use of a high flow, heated, humidified and controlled concentration of oxygen via the nasal route has several clinical benefits, including more precise oxygen delivery and improved patient comfort. Useful in both preoxygenation and apnoeic oxygenation, HFNC has been shown to prolong the safe apnoea window, reduce instances of hypoxaemia and allows clinicians more time to manage patients with difficult or compromised airways.1

Safe apnoea time refers to the time from cessation of breathing or ventilation, until the peripheral arterial oxygen saturation (SpO2) falls to 90%, after which it declines rapidly.2 Traditional pre-oxygenation techniques offer just 8 minutes of apnoea without desaturation.3 The high-flow rate and humidified system may extend the safe apnoeic up to 30 minutes (possibly more depending on the individual patient).4 Arterial oxyhaemoglobin desaturation caused by prolonged desaturation can trigger dysrhythmias, haemodynamic decompensation, hypoxic brain injury, and can ultimately be fatal.5 By extending this window of time, critical desaturation can be delayed, and clinicians have more time to implement the strategy that will ultimately prevent or reverse desaturation to prevent hypoxic injury.

In groups likely to show reduced oxygen reserves, such as obese, neonatal, paediatric, pregnant, septic, and critically ill patients, HFNC can be particularly effective. In these groups, there is an increased risk of faster desaturation and difficult airway management, both of which may be mitigated by employing HFNC pre-emptively

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Upcoming Events

AfPP Annual Conference 2022

University of York
8-11 September 2022

Infection 360: What's trending in infection prevention & control

Edgbaston Stadium, Birmingham
27-28 September 2022

IP2022 IS COMING TO BOURNEMOUTH IN OCTOBER 2022

Bournemouth
17-19 October 2022

UKHCA Conference: Listen Up

Pendulum Hotel and Manchester Conference Centre, Manchester
3rd November 2022

MEDICA 2022

Dusseldorf Germany
14th November - 17th November

Future Surgery 2022

ExCel, London
15th - 16th November 2022

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

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