Effectiveness of Apneic Oxygenation During Intubation: A Systematic Review and Meta-Analysis

Sleep disordered breathing has a strong association with difficult airways and postoperative adverse outcomes (including desaturation and reintubation). Apneic oxygenation may have an important role to play during emergency intubation. This group from Mayo Clinic conducted a systematic review and meta-analysis to evaluate the effectiveness of apneic oxygenation in airway management. Fourteen studies were included for qualitative review and 8 studies (comprising of 1,837 patients) for quantitative analysis. Apneic oxygenation decreased hypoxemia (OR 0.66; 95%CI 0.52-0.84), increased first-pass intubation success (OR 1.59; 95%CI 1.04-2.44), and increased lowest peri-intubation SpO2 (weighted mean difference 2.2%; 95%CI 0.8%-3.6%). This novel but under-utilized airway modality may have a role to play in difficult airway management in sleep-disordered breathing patients and other emergency intubations.