High oxygen fraction during airway opening is key to effective airway rescue in obese subjects

Laviola, Marianna; Christian, Niklas; Alahmadi, Husam; Das, Anup; Bates, Declan G; Hardman, Jonathan G

Abstract

Apnea is common after induction of anesthesia and may produce dangerous hypoxemia, particularly in obese subjects. Optimal management of airway emergencies in obese, apneic subjects is complex and controversial, and clinical studies of rescue strategies are inherently difficult and ethically-challenging to perform. We investigated rescue strategies in various degrees of obesity, using a highly-integrated, computational model of the pulmonary and cardiovascular systems, configured against data from 8 virtual subjects (body mass index [BMI] 24-57 kg m-2). Each subject received pre-oxygenation with 100% oxygen for 3 min, and then apnea with an obstructed airway was simulated until SaO2 reached 40%. At that time, airway rescue was simulated, opening of the airway with the provision of various patterns of tidal ventilation with 100% oxygen. Rescue using tidal ventilation with 100% oxygen provided rapid re-oxygenation in all subjects, even with small tidal volumes in subjects with large BMI. Overall, subjects with larger BMI pre-oxygenated faster and, after airway obstruction, developed hypoxemia more quickly. Our results indicate that attempts to achieve substantial tidal volumes during airway rescues are probably not worthwhile (and may be counter-productive); rather, it is the assurance of a high-inspired oxygen fraction that will prevent critical hypoxemia.

Citation

Laviola, M., Christian, N., Alahmadi, H., Das, A., Bates, D. G., & Hardman, J. G. (2019). High oxygen fraction during airway opening is key to effective airway rescue in obese subjects. In 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) (2357-2360). https://doi.org/10.1109/EMBC.2019.8857109

• Conference Name: 2019 41st Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC)
• Conference Location: Berlin, Germany
• Start Date: Jul 23, 2019
• End Date: Jul 27, 2019
• Acceptance Date: Apr 10, 2019
• Online Publication Date: Oct 7, 2019
• Publication Date: 2019-07
• Deposit Date: Sep 30, 2019
• Pages: 2357-2360
• Series ISSN: 1558-4615
• Book Title: 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)
• ISBN: 978-1-5386-1312-2
• DOI: https://doi.org/10.1109/EMBC.2019.8857109
• Public URL: https://nottingham-repository.worktribe.com/output/2648394
• Publisher URL: https://ieeexplore.ieee.org/document/8857109