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GENERAL ARTICLES

Preoxygenation with Tidal Volume and Deep Breathing Techniques: The Impact of Duration of Breathing and Fresh Gas Flow

Department of Anesthesiology, Illinois Masonic Medical Center, Chicago, Illinois

Address correspondence and reprint requests to M. Ramez Salem, MD, Department of Anesthesiology, Illinois Masonic Medical Center, 836 W. Wellington Avenue, Chicago, IL 60657. Address e-mail to njoseph{at}immc.org

Various techniques of "preoxygenation" before anesthetic induction have been advocated, including tidal volume breathing (TVB) for 3–5 min, four deep breaths (DB) in 0.5 min, and eight DB in 1 min. However, no study has compared the effectiveness of these techniques, assessed extending deep breathing beyond 1 min, or investigated the influence of fresh gas flow (FGF) in the same subjects using a circle absorber system. In 24 healthy adult volunteers breathing oxygen from a circle absorber system by tight-fitting mask, we compared TVB/5 min and deep breathing at a rate of 4 DB/0.5 min for 2 min at 5, 7, and 10 L/min FGF. Inspired and end-tidal respiratory gases were measured at 0.5-min intervals. During TVB, end-tidal oxygen (ETO₂) increased rapidly and plateaued by 2.5 min at 86%, 88%, and 88% with 5, 7 and 10 L/min FGF, respectively. ETO₂ values of 90% were attained between 3 and 4 min. Four DB/0.5 min increased ETO₂ to 75%, 77%, and 80% at 5, 7, and 10 L/min FGF. Eight DB/min resulted in ETO₂ values of 82% and 87% at 7 and 10 L/min, respectively. Extending deep breathing to 1.5 and 2 min with 10 L/min FGF increased ETO₂ by 90%, although a decrease in ETCO₂ was noted. We concluded that TVB/3–5 min was effective in achieving maximal "preoxygenation" whereas 4 DB/0.5 min resulted in submaximal "preoxygenation," and thus should be used only when time is limited. Increasing FGF from 5 to 10 L/min does not enhance "preoxygenation" with either TVB or 4 DB/0.5 min. Deep breathing yields maximal "preoxygenation" when extended to 1.5 or 2 min, and only when high (10 L/min) FGF is used.

Implications: Using a circle absorber system, normal breathing of oxygen for 3–5 min achieves optimal oxygenation of the lungs; whereas 4 deep breaths in 30 s does not. However, extending deep breathing to 1.5–2 min and using a high flow of oxygen improves oxygenation of the lungs to the same degree as normal breathing for 3–5 min. This may have important implications for patient safety.

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