Abstract
Purpose
Ideally, preoxygenation is performed using a tight fitting mask either by breathing normally for three to five minutes or with four to eight vital capacity (VC) breaths in 0.5 to one minute, but in practice leaks are frequent and sometimes unavoidable. This study was designed to determine which breathing method provided the best oxygenation in the presence of leak.
Methods
Twenty volunteers were instructed to breathe from a circle circuit supplied with 6 L·min-1 of fresh oxygen. Each subject was tested under four situations selected in random order: 1) normal breathing for three minutes without leak; 2) normal breathing for three minutes with a leak; 3) four VCs in 30 sec without a leak; and 4) four VCs in 30 sec with a leak. The leak was created by a piece of size 18 French nasogastric tube, 5 cm long, taped under the face mask. Inspired and expired O2 and CO2 were sampled at the nostrils.
Results
In the absence of a leak, the end-tidal oxygen fraction (FEO2) was greater after three minutes of tidal breathing (89 ± 3%; mean ± SD) in comparison with the response to four VCs (76 ± 7%; P < 0.001). Introduction of a leak decreased the FEO2 significantly (P < 0.001). With a leak, the FEO2 was similar with normal breathing (61 ± 8%) and after four VCs (59 ± 11%).
Conclusion
Preoxygenation with tidal volume breathing for three minutes yields higher FEO2 in comparison to four VCs. If a small leak (4 mm internal diameter) is introduced, the FEO2 decreases significantly with both breathing methods to approximately 60%.
Résumé
Objectif
Idéalement la préoxygénation est effectuée avec un masque étanche selon deux techniques; soit en respirant normalement pendant trois à cinq minutes ou en prenant quatre à huit respirations à capacité vitale (CV) en 0,5 à une minute. En pratique, les fuites sont fréquentes et quelquefois incontournables. Cette étude fut réalisée pour déterminer quelle méthode produit la meilleure préoxygénation en présence de fuite.
Méthode
Vingt volontaires ont respiré dans un circuit en cercle fournissant 6 L·min-1 ďoxygène frais. Chaque sujet fut soumis à quatre situations sélectionnées de façon aléatoire: 1) respiration normale pour trois minutes sans fuite; 2) respiration normale pour trois minutes avec fuite; 3) quatre CV en 30 sec sans fuite; 4) quatre CV en 30 sec avec fuite. La fuite a été créée avec un segment de tube nasogastrique de taille 18, long de 5 cm, fixé sous le masque. Les fractions inspirées et expirées ďO2 et de CO2 ont été mesurées aux narines.
Résultats
En ľabsence de fuite, la fraction expirée ďoxygène (FEO2) est plus grande avec trois minutes de respiration normale (89 ± 3%; moyenne ± ET) qu’avec quatre CV (76 ± 7%, P < 0,001). Avec une fuite, la FEO2 diminue significativement (P < 0,001). En présence ďune fuite, la FEO2 est la même avec respiration normale (61 ± 8%) qu’avec quatre respirations profondes (59 ± 11%).
Conclusion
Une préoxygénation avec respiration normale pour trois minutes donne une FEO2 plus élevée qu’avec quatre C V. Si une petite fuite (4 mm de diamètre interne) est présente, la FEO2 s’abaisse de façon significative à environ 60 % avec les deux méthodes de préoxygénation.
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An erratum to this article is available at http://dx.doi.org/10.1007/BF03021640.
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Gagnon, C., Fortier, LP. & Donati, F. When a leak is unavoidable, preoxygenation is equally ineffective with vital capacity or tidal volume breathing. Can J Anesth 53, 86–91 (2006). https://doi.org/10.1007/BF03021532
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DOI: https://doi.org/10.1007/BF03021532