Driver B, et al’s “Flush Rate Oxygen for Emergency Airway Preoxygenation” wins best airway article

Congratulations to Brian Driver MD, Matthew Prekker MD, Rebecca Kornas MD, Ellen Cales MD, and Robert Reardon MD, winners of the 2016 Airway Article of the Year award for Flush Rate Oxygen for Emergency Airway Preoxygenation.

Airway Management Education Center, the creators of The Difficult Airway Course™, hosted the fifth annual “Airway Article of the Year” award show as a live webinar on December 15, 2016.  Webinar host, Calvin Brown III, MD presented three articles as finalists.  The nominees were selected from among all of the articles covered during the Airway Management Research Update webinars held in 2016.  The content and merits of each article were presented and the winner was chosen by a vote of the on-line audience during the show.  The recorded show is available at www.airwayworld.com/webinars and as a podcast on iTunes.

The 2016 Nominees

The nominees for this honor were:

• Driver B et al. Flush Rate Oxygen for Emergency Airway Preoxygenation. Ann Emerg Med 2016 [epub].

• Guy Y et al.  A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Can J Anaesth 2016 Aug; 63:928.

• Sakles JC et al. First Pass Success without Hypoxemia is increased with Apneic Oxygenation during RSI in the Emergency Department. Acad Emerg Med 2016 Jun;23(6):703-10.

The 2016 Winner

The winner of the “Airway Article of the Year” is Flush Rate Oxygen for Emergency Airway Preoxygenation by Brian Driver MD, Matthew Prekker MD, Rebecca Kornas MD, Ellen Cales MD, and Robert Reardon MD.

In Driver’s study, researchers compared the efficacy of preoxygenation with a non-rebreather mask (NRB) using flush flow rate oxygen (~50 L/min by fully opening a standard oxygen flowmeter) to a bag-valve-mask (BVM) device or NRB mask device at standard flow rates (15 L/min).  The primary endpoint was end-tidal O₂ (ETO₂) as a surrogate for preoxygenation and nitrogen washout.

They found that preoxygenation with an NRB mask using flush flow rate oxygen was better than a NRB mask at 15L/min and that a NRB mask with flush rate oxygen was not inferior to a BVM at 15L/min.  This led them to conclude that use of a NRB mask with flush rate oxygen is a reasonable preoxygenation alternative for spontaneously breathing patients undergoing emergency airway management.

According to Dr. Brown, “One of the most valuable contributions of this study is that it adds one more option if your patient is not oxygenating well on a NRB at 15L.  A critical component of patient safety during emergency airway management is preoxygenation.  Previously, if a NRB mask device at standard flow rates was not adequate, preoxygenating through a manually applied BVM or BiPAP was required. This provides an easy alternative and now you may not have to move to BiPAP or start your airway maneuvers with less than ideal saturations.  Just turn the knob all the way up on the oxygen flowmeter so you get the maximum flush flow rate.”  “This study has a very tangible and inexpensive take-home message,” Dr. Brown added. “You may be able to improve your airway management by simply maximizing the equipment you already have.  I started doing this immediately after I read this study and have seen improvements in preoxygenation.”

Dr. Driver’s study clearly resonated with the audience who selected him for this honor.  Congratulations to Dr. Driver and his team!

The “Airway Article of the Year” award show and Quarterly Airway Management Research Update webinars can be viewed on Airway World at www.airwayworld.com/webinars.  Both are also available as podcasts on Airway World or in the iTunes Store (Airway World Podcasts).  Questions about Airway World or the Quarterly Airway Management Research Updates can be sent to Terry T. Steele at tsteele@theairwaysite.com.