Oxygénation Nasale Humidifiée à Haut Débit - Optiflow aux urgences COMUN 2018

Quelle est la place de l'Optiflow aux urgences ?
Où en est-on des études cliniques ?
Peut-on traiter les patients des urgences comme ceux de réanimation avec l'oxygénation haut-débit ?
De nouvelles perspectives avec l'Optiflow ?

1. Nicolas PESCHANSKI
MD, PhD –CHI Eure-Seine Evreux
MEDECINE d’urgence

2. Consultant
Congrès/Symposiums
Investigateur
Congrès/Symposiums

3. Principes

4. Heated-Humidified HFNO
➚60 l/min
FiO2> 90%Effet PEP 2-3 cmH2O

5. High-Flow Nasal Ox
Concept
1985

6. 1986-1991
Animal

7. NICU
2001

8. 2009

10. IRA

11. Effets sur 48 heures auprès de 40 patients dont 20 avec pneumonies
IRA

12. Effets sur 48 heures auprès de 40 patients dont 20 avec pneumonies
IRA

13. IRA

14. IRA

15. Etat de l’Art

16. IRA
Ni YN, et al. CHEST 2017; 151(4):764-775 Ni YN, et al. Chest2017;151(4):764-75

17. HDN versus Oxy. Conv. (COT)
HDN versus VNI
Pneumopathies
IRA

18. ?

19. Spoletini G, et al. Chest. 2015;148(1):253-61
Effets bénéfiques…

20. Spoletini G, et al. Chest. 2015;148(1):253-61
Pratique clinique…
8
T Desmettre EMC2 2016

21. Sztrymf et al. Int Care Med. 2011
Rittayamai et al. Respir Care. 2014
Lenglet et al. Respir Care. 2012
Rittayamai et al. Respir Care. 2015
Etat de l’art…

22. Transposer…?

23. Spoletini G, et al. Chest. 2015;148(1):253-61
Transposer…?

24. État de l’art Urgences

25. HFNCO2= 998
HFNCO2+ Trials = 160
HFNCO2+ Trials + Urgences = 24
HFNCO2+ RCT + Urgences (Adultes) = 6
HFNCO2+ Urgences + Guidelines = 1 (Inde)

26. Quels Critères ?
RCT

27. Lenglet H, et al. Respir Care 2012;57(11):1873-8.
Pneumoniawas the most common reason for
oxygen therapy (9/17)
HFNC is possible in the ED, and it alleviated
dyspnea and improved respiratory parameters in
subjects with acute hypoxemic respiratory failure.
Humidified High Flow Nasal Oxygen During
Respiratory Failure in the Emergency Department:
Feasibility and Efficacy
Pionniers…

28. HOT-ERJones PG et al. Respir Care 2016

29. HOT-ER
Jones PG et al. Respir Care 2016
CONCLUSIONS: HFNC was not shown to reduce the need for mechanical ventilation
in the emergency department for subjects with acute respiratory distress compared with
standard O2, although it was safeand may reduce the need for escalation of oxygen
therapy within the first 24 h of admission
C’est de l’Urgence !!

30. OAP cardiogénique
Makdee O, et al. Ann Emerg Med.2017;70(4):465-472
VS.

31. OAP cardiogénique
Makdee O, et al. Ann Emerg Med.2017;70(4):465-472

32. Dyspnée & Hypoxémie
Rittayamai N, et al. Respir Care 2015;60(10):1377–1382
Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia
in the Emergency Department
Nuttapol Rittayamai MD, Jamsak Tscheikuna MD, Nattakarn Praphruetkit MD, and
Sunthorn Kijpinyochai MD
BACKGROUND: Acute dyspnea and hypoxemia are 2 of the most common problems in the
emergency room. Oxygen therapy is an essential supportive treatment to correct these issues. In this
study, we investigated the physiologic effects of high-flow nasal oxygen cannula (HFNC) compared
with conventional oxygen therapy (COT) in subjects with acute dyspnea and hypoxemia in the
emergency room. METHODS: A prospective randomized comparative study was conducted in the
emergency department of a university hospital. Forty subjects were randomized to receive HFNC
or COT for 1 h. The primary outcome was level of dyspnea, and secondary outcomes included
change in breathing frequency, subject comfort, adverse events, and rate of hospitalization.
RESULTS: Common causes of acute dyspnea and hypoxemia were congestive heart failure, asthma
exacerbation, COPD exacerbation, and pneumonia. HFNC significantly improved dyspnea (2.0!1.8
vs 3.8!2.3,P".01) and subject comfort (1.6!1.7 vs 3.7!2.4,P".01) compared with COT.
No statistically significant difference in breathing frequency was found between the 2 groups at
the end of the study. HFNC was well tolerated, and no serious adverse events were found. The
rate of hospitalization in the HFNC group was lower than in the COT group, but there was no
statistically significant difference (50% vs 65%,P".34). CONCLUSIONS: HFNC improved
dyspnea and comfort in subjects presenting with acute dyspnea and hypoxemia in the emer-
gency department. HFNC may benefit patients requiring oxygen therapy in the emergency
room.Key words: high-flow nasal oxygen cannula; oxygen therapy; dyspnea; hypoxemia; emergency
room.[RespirCare2015;60(10):1377–1382.©2015DaedalusEnterprises]
Introduction
Acute dyspnea with accompanying hypoxemia is a ma-
jor problem in emergency departments. Common causes
of this condition include acute pulmonary edema, pneu-
monia, and exacerbation of chronic obstructive airway dis-
eases such as asthma and COPD. Specific therapy for the
underlying disease is the mainstay of treatment. However,
oxygen therapy is an essential supportive treatment tocor-
rect hypoxemia and alleviate breathlessness.
1
Oxygen supply
via a nasal cannula or non-rebreathing mask is routinely used,
but these methods may be inadequate to support patients’
increased work of breathing, particularly if they require a
high inspiratory flow (range of 30–120 L/min in acute respi-
ratory failure).
2
Furthermore, variations in F
IO
2
occur with
conventional oxygen therapy (COT), and delivered F
IO
2
de-
pends on oxygen flow and the patient’s breathing pattern.
3
High-flow nasal cannula (HFNC) is a heated, humidi-
fied, high-flow oxygen delivery system that can generate
Drs Rittayamai and Tscheikuna are affiliated with the Division of Re-
spiratory Diseases and Tuberculosis, Department of Medicine, and Drs
Praphruetkit and Kijpinyochai are affiliated with the Department of Emer-
gency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol Univer-
sity, Bangkok, Thailand.
This study was supported by Grant R015531049 from the Faculty of
Medicine Siriraj Hospital, Mahidol University. The authors have dis-
closed no conflicts of interest. This is Thai Clinical Trials Registry iden-
tifier TCTR20140618002.
Correspondence: Nuttapol Rittayamai MD, Division of Respiratory Dis-
eases and Tuberculosis, Department of Medicine, Faculty of Medicine
Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi Dis-
trict, Bangkok 10700, Thailand. E-mail: [email protected]: 10.4187/respcare.03837
RESPIRATORYCARE•OCTOBER2015 VOL60 NO10 1377
fort. In addition, HFNC was better tolerated and provided
better comfort compared with COT. An observational study
by Lenglet et al
11
showed that HFNC decreased dyspnea
scores compared with COT in subjects with acute respi-
ratory failure presenting to an emergency department. Fur-
thermore, Schwabbauer et al
12
found that HFNC signifi-
cantly reduced dyspnea and improved comfort compared
with noninvasive ventilation in subjects with hypoxemic
respiratory failure. In addition, the subjects in the present
study tolerated HFNC very well, and no serious adverse
events occurred during the study period. Furthermore, sub-
jects who received HFNC trended toward reduced hospi-
talization, but this was not found to be statistically signif-
icant.
Improvement of dyspnea by HFNC can be explained by
several mechanisms, including the high gas flow matching
subjects’ demand,
13
decreased pharyngeal dead space,
5,14,15
low levels of positive airway pressure,
16-19
improved tho-
racoabdominal synchrony,
20
and reduced symptoms of mu-
cosal dryness with heated-and-humidified gas.
21-23
In ad-
dition, all of these mechanisms also explain why HFNC
improved gas exchange and subject comfort. The advan-
tage of HFNC in terms of improving dyspnea, subject
comfort, and oxygenation has also been noted in other
subject populations, such as post-cardiac surgery
8
and post-
endotracheal extubation subjects,
7,9
and during fiberoptic
bronchoscopy.
24
Several studies demonstrated that HFNC reduced breath-
ing frequency and also improved oxygenation in subjects
Fig. 2. Change in level of dyspnea assessed using a numerical
rating scale (0 –10) between high-flow nasal cannula (HFNC) and
conventional oxygen therapy. HFNC significantly improved dys-
pnea as early as 5 min after application, and this effect continued
to the end of the study, except at 30 min. *P!.05.
Table 1. Baseline Characteristics of the Groups of Randomized Subjects
Characteristic HFNC ( n"20) COT ( n"20) P
Age, mean#SD y 65.6 #14.4 63.6 #15.7 .26
Females,n(%) 11 (55.0) 14 (70.0) .51
Underlying disease,n(%)
Cardiovascular 7 (35.0) 3 (15.0) .14
Respiratory 8 (40.0) 10 (50.0) .38
Diabetes mellitus 5 (25.0) 9 (45.0) .16
Hypertension 10 (50.0) 10 (50.0) .62
Other 5 (25.0) 6 (30.0) .50
Diagnosis in emergency department,n(%)
Congestive heart failure 9 (45.0) 5 (25.0) .16
Asthmatic attack 2 (10.0) 5 (25.0) .20
COPD exacerbation 3 (15.0) 2 (10.0) .50
Pneumonia 3 (15.0) 6 (30.0) .23
Other 3 (15.0) 2 (10.0) .50
Co-treatment,n(%)
Diuretics 8 (40.0) 5 (25.0) .25
Bronchodilators 12 (60.0) 14 (70.0) .37
Corticosteroids 7 (35.0) 7 (35.0) .63
Antibiotics 4 (20.0) 5 (25.0) .50
Initial physiologic parameters
Breathing frequency, mean#SD breaths/min 31.7 #5.5 32.1 #5.0 .81
Mean arterial pressure, mean#SD mm Hg 100.4 #22.9 104.6 #16.9 .51
Heart rate, mean#SD beats/min 93.5 #16.2 107.7 #24.0 .04
S
pO
2
, mean#SD % 85.9#9.0 88.7 #4.5 .23
HFNC"high-flow nasal oxygen cannula
COT"conventional oxygen therapy
HFNCFORACUTEDYSPNEA ANDHYPOXEMIA
1380 R ESPIRATORYCARE•OCTOBER2015 VOL60 NO10
with acute respiratory failure.
25-28
In the present study, we
found that HFNC significantly reduced breathing frequency
during the study period, but there was no significant dif-
ference at the end of the study. This could be explained by
the effect of specific treatments such as bronchodilator
medications or diuretics, which had time to act and mod-
ified the pathophysiology of the subjects’ presentation.
29-33
Patients receiving HFNC should be closely monitored
using parameters similar to those used during noninvasive
ventilation. Messika et al
34
found that HFNC failure was
associated with lower P
aO
2
/F
IO
2
and higher breathing fre-
quency and Simplified Acute Physiology Score II. In ad-
dition, in a retrospective observational study on subjects
with acute respiratory failure, Kang et al
35
found that HFNC
failure led to delayed endotracheal intubation and worse
clinical outcomes. In the present study, no subject was
intubated or received noninvasive ventilation because they
were less sick compared with the subjects in the above-
mentioned studies. Thus, appropriate selection and fre-
quent re-evaluation of patients during HFNC use will help
to improve outcomes, particularly in the emergency de-
partment.
This study has some limitations. First, there was a 1.5-h
delay on average between the screening period and proto-
col initiation. Second, we did not measure delivered F
IO
2
in the COT group because this technique was difficult to
perform in the emergency department. Third, arterial blood
gases were not measured during the study. This was an
important limitation for comparing gas exchange between
the 2 groups and the potential changes in P
aCO
2
from ox-
ygen therapy, particularly in subjects with COPD.
Conclusions
In conclusion, HFNC resulted in less dyspnea and better
comfort in comparison with COT in subjects presenting to
the emergency department with acute dyspnea and hypox-
emia. This device may benefit patients requiring oxygen
therapy in the emergency department.
ACKNOWLEDGMENTS
We thank Mr Suthipol Udompanthurak MSc (Clinical Epidemiology
Unit, Department of Health Research and Development, Faculty of Med-
icine Siriraj Hospital, Mahidol University, Bangkok, Thailand) for his
contribution to the statistical analysis.
REFERENCES
1. O’Driscoll BR, Howard LS, Davison AG. Emergency oxygen use in
adult patients: concise guidance. Clin Med 2011;11(4):372-375.
2. L’Her E, Deye N, Lellouche F, Taille S, Demoule A, Fraticelli A, et
al. Physiologic effects of noninvasive ventilation during acute lung
injury. Am J Respir Crit Care Med 2005;172(9):1112-1118.
3. O’Driscoll BR, Howard LS, Davison AG, British Thoracic Society.
BTS guideline for emergency oxygen use in adult patients. Thorax
2008;63(Suppl 6):vi1-vi68.
4. Ricard JD. High flow nasal oxygen in acute respiratory failure. Min-
erva Anestesiol 2012;78(7):836-841.
5. Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow
therapy: mechanisms of action. Respir Med 2009;103(10):1400-1405.
6. Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy
in acute respiratory failure. Respir Care 2010;55(4):408-413.
7. Rittayamai N, Tscheikuna J, Rujiwit P. High-flow nasal cannula
versus conventional oxygen therapy after endotracheal extubation: a
randomized crossover physiologic study. Respir Care 2014;59(4):
485-490.
8. Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF. Oxygen
delivery through high-flow nasal cannulae increases end-expiratory
lung volume and reduces respiratory rate in post-cardiac surgical
patients. Br J Anaesth 2011;107(6):998-1004.
9. Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antoni-
celli F, et al. Nasal high-flow versus Venturi mask oxygen therapy
after extubation. Effects on oxygenation, comfort, and clinical out-
come. Am J Respir Crit Care Med 2014;190(3):282-288.
10. Bausewein C, Farquhar M, Booth S, Gysels M, Higginson IJ. Mea-
surement of breathlessness in advanced disease: a systematic review.
Respir Med 2007;101(3):399-410.
11. Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD.
Humidified high flow nasal oxygen during respiratory failure in the
emergency department: feasibility and efficacy. Respir Care 2012;
57(11):1873-1878.
12. Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J, Riessen
R. Nasal high-flow oxygen therapy in patients with hypoxic respi-
ratory failure: effect on functional and subjective respiratory param-
eters compared to conventional oxygen therapy and non-invasive
ventilation (NIV). BMC Anesthesiol 2014;14:66.
Table 2. Comparing Clinical and Physiologic Parameters for the HFNC and COT Groups at the End of the Study
Parameter HFNC COT P
Dyspnea scale score, mean!SD 2.0 !1.8 3.8 !2.3 .01
Breathing frequency, mean!SD breaths/min 26.0 !6.2 27.5 !4.9 .82
Mean arterial pressure, mean!SD mm Hg 88.7 !10.9 101.0 !24.8 .31
Heart rate, mean!SD beats/min 91.7 !19.3 101.6 !24.2 .04
S
pO
2
, mean!SD % 96.8!2.5 97.6 !2.0 .13
Comfort scale score, mean!SD 1.6 !1.7 3.7 !2.4 .01
HFNC"high-flow nasal oxygen cannula
COT"conventional oxygen therapy
HFNCFORACUTEDYSPNEA ANDHYPOXEMIA
RESPIRATORYCARE•OCTOBER2015 VOL60 NO10 1381

33. Pathologies -> IRA
ICCBPCO
IRCAsthme
HTAPSAOS…
PAC
SICA
EP
SCA
…
Wilt TJ, et al. Ann Intern Med. 2007;147:639–53.

34. IRA
Durey A, et al . Am JEmerg Med.2017;70(4):465-472

35. IRA
Durey A, et al . Am JEmerg Med.2017;70(4):465-472
Inourstudy,cardiogenicpulmonaryedemawasobservedmorefrequently
inthesuccessgroupandthefindingofbilateralpulmonaryinfiltrateson
chestX-raywasmorecommoninthesuccessgroupaswell.
Whereas,thepercentageofpneumoniawashigherinthefailuregroup.

36. NEXT ?

37. Pré-Ox

38. Pré-oxygénation Réa
CONCLUSIONS
Compared to HFFM, HFNC as a preoxygenation device did not
reduce the lowest level of desaturation

39. CONCLUSIONS
A novel strategy for preoxygenation in hypoxaemic patients, adding HFNC for apnoeic
oxygenation to NIV prior to orotracheal intubation, may be more effective in reducing
the severity of oxygen desaturation than the reference method using NIV alone.
Pré-oxygénation Réa

40. Papazian L. et al. ICM 2016
Indications Urgences ?

41. On y travaille…
Hayes-Bradley C, et al. An Emerg Med 2016
Efficacy of Nasal Cannula Oxygen as a
Preoxygenation Adjunct in Emergency
Airway Management
Clare Hayes-Bradley, BSc, MBBS*; Anthony Lewis, MBBCh, PhD; Brian Burns, MBBCh, MSc; Matt Miller, MBChB
*Corresponding Author. E-mail:[email protected], Twitter:@ClareHBradley.
Study objective:Although preoxygenation for emergency airway management is usually performed with nonrebreather
face masks or bag-valve-mask devices, some clinicians also deliver supplemental high-flow oxygen by nasal cannula.
We aim to measure the efficacy of supplemental nasal cannula oxygen delivery to conventional bag-valve-mask and
nonrebreather face mask preoxygenation both with and without a simulated face mask leak.
Methods:We conducted a randomized crossover trial using healthy volunteers. We randomized subjects to
preoxygenation with bag-valve-mask or nonrebreather face mask. In random sequence, subjects underwent 3-minute
trials of preoxygenation with oxygen through mask alone at 15 L/min, oxygen through mask at 15 L/min with standardized
leak, oxygen through mask at 15 L/minþoxygen through nasal cannula at 10 L/min, and oxygen through mask at 15 L/
minþoxygen through nasal cannula at 10 L/min with standardized leak. The primary outcome was single-breath exhalation
end-tidal oxygen (ETO
2). We comparedETO
2between preoxygenation modalities, using nonparametric techniques.
Results:We enrolled 60 subjects (30 nonrebreather face mask and 30 bag-valve-mask). In scenarios without a mask
leak,ETO
2was similar between bag-valve-mask and bag-valve-maskþnasal cannula (mean 79% versus 75%; difference
–3%; 95% confidence interval [CI]–8% to 1%). In bag-valve-mask scenarios with a mask leak,ETO2was higher for bag-
valve-maskþnasal cannula than bag-valve-mask alone (mean 66% versus 41%; difference 25%; 95% CI 21% to 29%).
ETO
2was higher for nonrebreather face maskþnasal cannula than nonrebreather face mask (mean 67% versus 52%;
difference 15%; 95% CI 12% to 18%). In nonrebreather face mask scenarios with a mask leak,ETO2was higher for
nonrebreather face maskþnasal cannula than nonrebreather face mask (mean 65% versus 48%; difference 17%; 95%
CI 13% to 20%).
Conclusion:Although not aiding bag-valve-mask preoxygenation with a good mask seal, supplemental nasal cannula
oxygen improved preoxygenation efficacy in the presence of a bag-valve-mask mask leak. Supplemental nasal cannula
oxygen improved nonrebreather face mask preoxygenation both with and without a mask leak. Supplemental nasal
cannula oxygen may be helpful for preoxygenation before emergency airway management. [Ann Emerg Med.
2016;68:174-180.]
Please see page 175 for the Editor’s Capsule Summary of this article.
Afeedbacksurvey is available with each research article published on the Web atwww.annemergmed.com.
Apodcastfor this article is available atwww.annemergmed.com.
0196-0644/$-see front matter
Copyright © 2015 by the American College of Emergency Physicians.
http://dx.doi.org/10.1016/j.annemergmed.2015.11.012
INTRODUCTION
Background
In emergency airway management and rapid sequence
intubation, clinicians commonly perform preoxygenation
before performing laryngoscopy and intubation.
Preoxygenation denitrogenates the functional residual
capacity of the lungs, creating an oxygen reservoir to allow
periods of apnea during intubation.
1
Preoxygenation is
essential to help prevent hypoxemia during emergency
airway management.
2,3
Common devices used for emergency airway
preoxygenation include bag-valve-mask and the
nonrebreather face mask, both of which vary by
manufacturer in their delivered FiO2.
4-8
In addition to
bag-valve-mask or nonrebreather face mask, some clinicians
provide supplemental high-flow oxygen through nasal
cannula to increase the total oxygenflow. Bag-valve-mask or
nonrebreather face mask seal may be difficult to maintain in
emergency airway cases (for example, because of facial
injuries or agitation), compromising preoxygenation, so
174AnnalsofEmergency Medicine Volume 68, no. 2 :August2016
AIRWAY/ORIGINAL RESEARCH
Editor’s Capsule Summary
What is already known on this topic
Before emergency airway management, clinicians
commonly perform preoxygenation with bag-valve-
mask or nonrebreather mask.
What question this study addressed
Does supplemental high-flow nasal cannula oxygen
improve preoxygenation?
What this study adds to our knowledge
In this randomized trial on 60 healthy volunteers,
nasal cannula oxygen at 10 L/min improved end-tidal
oxygen levels with nonrebreather mask,
nonrebreather with a mask leak, and bag-valve-mask
with a mask leak. Addition of nasal cannula did not
improve end-tidal oxygen with well-sealed bag-valve-
mask.
How this is relevant to clinical practice
Although requiring validation in clinical emergency
department patients, supplemental nasal cannula
oxygen may aid emergency airway management
preoxygenation efforts.
some clinicians advocate the use of supplemental high-flow
nasal cannula oxygen in the presence of a mask leak.
9-11
Importance
Although supplemental nasal cannula oxygen for
preoxygenation before emergency airway management
theoretically increases oxygen delivery, to our knowledge
there are no studies evaluating its efficacy. In addition, to
our knowledge there are no studies evaluating the efficacy
of supplemental nasal cannula oxygen for rapid sequence
intubation preoxygenation in the presence of a bag-valve-
mask or nonrebreather face mask leak.
Goals of This Investigation
In this study using healthy volunteers, we sought to
assess the efficacy of supplemental nasal cannula oxygen in
preoxygenation for simulated emergency airway
management, with and without face mask leak.
MATERIALS AND METHODS
Study Design and Setting
We performed a randomized crossover study using
healthy volunteers. All trials were conducted in the
operating room or ICU of St George Hospital. The study
was approved by the South Eastern Sydney Local Heath
District Ethics Review Committee (HREC/15/POWH/
54) and registered at the Australia and New Zealand
Clinical Trials Registry.
Selection of Participants
Volunteers were requested from operating theater,
emergency department (ED), or ICU staff at St George
Hospital. Exclusion criteria were known respiratory or cardiac
disease; current cardiac or respiratory medications, including
inhalers; pregnancy; exposure to bleomycin or amiodarone;
andfacial hair or previousfacial injury likelytoaffect maskseal.
Male volunteers were asked to be clean-shaven on the day of
testing. One participant was excluded before commencing
because of previous exposure to amiodarone.
Interventions
After informed consent, each participant was
randomized to either nonrebreather face mask or bag-valve-
mask according to a random sequence generated with the
statistical software R (version 3.1.2; R Foundation for
Statistical Computing). Participants then underwent 4
trials of preoxygenation consisting of mask alone (bag-
valve-mask or nonrebreather face mask), mask (bag-valve-
mask or nonrebreather face mask) with simulated leak,
maskþnasal cannula (bag-valve-maskþnasal cannula or
nonrebreather face maskþnasal cannula), and maskþnasal
cannula with simulated leak (Figure 1). The sequence of
the 4 trials was randomized with a balanced Latin square
design so that the order of trials of one participant was
completed in the opposite order of another participant.
Bag-valve-mask preoxygenation was performed with a
disposable self-inflating resuscitator (bag-valve-mask) with
a 2-L reservoir bag (Mayo Healthcare, Mascot, NSW,
Australia) and expiratory cap
12
connected to a heat
moisture exchangefilter and catheter mount. For the
nonrebreather face mask, we used a standard adult
nonrebreather mask with reservoir and safety vent (Mayo
Healthcare).
13
Adult straight-prong nasal cannulae (Mayo
Healthcare)
14
were used for all participants. For both bag-
valve-mask and nonrebreather face mask, oxygen was
delivered at 15 L/min. The adult nasal cannula oxygen
flow rate was set at 10 L/min.
To create simulated mask leaks, we used 2 pieces of
4-cm-long nontapering portions of 16-French nasogastric
tube (Medtronic, Minneapolis, MN). We inserted the
pieces of nasogastric tube under both sides of the mask on
the upper lip to create a standard disruption to the mask
seal (Figure 2).
Volume68, no. 2 :August2016 AnnalsofEmergency Medicine175
Hayes-Bradley et al Effect of Nasal Cannula Oxygen as Preoxygenation Adjunct

42. INDICATIONS
Hypoxie
OAPc
BPCO
Pré-Ox

43. Améliorations des échanges gazeux
Critères !!!

44. Fréquence respiratoire
SpO2
Gaz du sang artériel
Mesurer

45. Echelle de dyspnée
EVA «confort»
Taux d’abandon
Evaluer

46. Nouveau mode d’oxygénation
sans intubation
ni trachéotomie
Comparer Gold Standard ?

47. Questions ?
Nicolas PESCHANSKI
Urgences Adultes –SAMU 27
CHI
Eure-Seine
@DocNikko