High-Flow Nasal Cannula Therapy for Apneic Oxygenation during Rapid Sequence Induction in the Emergency Department: A Systematic Review
If you are managing a patient requiring RSI and are concerned about apneic hypoxemia, consider initiating HFNC as an adjunctive oxygen source. However, do not rely on it expecting to alter major clinical outcomes like mortality; the evidence for this is weak. Use your judgment based on local protocols while remaining aware that its benefit over standard care remains unproven.
This systematic review synthesized the current literature regarding the use of high-flow nasal cannula (HFNC) specifically to manage oxygenation during the apneic period encountered during rapid sequence induction (RSI) in the emergency department setting. The authors assessed whether providing continuous, high-flow oxygen could improve oxygenation status or reduce adverse events associated with controlled apnea. While some individual studies suggested that HFNC might correlate with a longer safe duration of apnea without desaturation, the review noted a critical absence of data demonstrating any impact on major clinical endpoints such as mortality rates or overall incidence of significant desaturation events. Overall, the evidence suggests HFNC is an adjunct option for oxygenation during this vulnerable period, but its utility in improving definitive patient outcomes remains unproven based on current data.