Apnoeic CPAP for oxygenation of COVID-19 patients prior to intubation
Inability to adequately pre-oxygenate critically ill patients, and to maintain oxygenation during induction and laryngoscopy, risks life-threatening hypoxaemia. Intubation of COVID-19 patients is made considerably more complex due to the risk of viral transmission associated with different pre-oxygenation and apnoeic oxygenation strategies.
In this excellent 10 minute video from Adult Retrieval Victoria, Dr Stacy Turner (@StacyTurner99) demonstrates the pros and cons of different approaches for “apnoeic CPAP” to achieve adequate oxygenation of critically ill COVID-19 patients. The current Safe Airway Society COVID-19 Consensus Statement – Airway Management and Tracheal Intubation. are referred to in the video.
Techniques demonstrated include:
- Bag-valve-mask (BVM) with PEEP valve
- Bag-valve-mask (BVM) with PEEP valve and nasal cannula
- Bag-valve-mask (BVM) with PEEP valve and addition oxygen flow distal to the viral filter
- CPAP using the Hamilton C1 ventilator
novel coronavirus of COVID-19
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.