title: How to preoxygenate in operative room: healthy subjects and situations "at risk".
abstract: Intubation is one of the most common procedures performed in operative rooms. It can be associated with life-threatening complications when difficult airway access occurs, in patients who cannot tolerate even a slight hypoxemia or when performed in patients at risk of oxygen desaturation during intubation, as obese, critically-ill and pregnant patients. To improve intubation safety, preoxygenation is a major technique, extending the duration of safe apnoea, defined as the time until a patient reaches an arterial saturation level of 88% to 90%, to allow for placement of a definitive airway. Preoxygenation consists in increasing the lung stores of oxygen, located in the functional residual capacity, and helps preventing hypoxia that may occur during intubation attempts. Obese, critically-ill and pregnant patients are especially at risk of reduced effectiveness of preoxygenation because of pathophysiological modifications (reduced functional residual capacity (FRC), increased risk of atelectasis, shunt). Three minutes tidal volume breathing or 3-8 vital capacities are recommended in general population, mostly allowing achieving a 90% end-tidal oxygen level. Recent studies have indicated that in order to maximize the value of preoxygenation (i.e, oxygenation stores) obese and critically-ill patients can benefit from the combination of breathing 100% oxygen and non-invasive positive pressure ventilation (NIV) with end-expiratory positive pressure (PEEP) in the proclive position (Trendelenburg reverse). Recruitment manoeuvres may be of interest immediately after intubation to limit the risk of lung derecruitment. Further studies are needed in the field of preoxygenation in pregnant women.
authors.affiliation: Unité Inserm U1046, Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint-Eloi Teaching Hospital, Université Montpellier 1, Université Montpellier 2, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: De Jong
authors.affiliation: Département d'Anesthésie et Réanimation, Hôpital Estaing, Université de Clermont-Ferrand, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France.
authors.forename: E
authors.initials: E
authors.lastname: Futier
authors.affiliation: Unité Inserm U1046, Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint-Eloi Teaching Hospital, Université Montpellier 1, Université Montpellier 2, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Millot
authors.affiliation: Unité Inserm U1046, Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint-Eloi Teaching Hospital, Université Montpellier 1, Université Montpellier 2, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Coisel
authors.affiliation: Unité Inserm U1046, Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint-Eloi Teaching Hospital, Université Montpellier 1, Université Montpellier 2, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
authors.forename: B
authors.initials: B
authors.lastname: Jung
authors.affiliation: Unité Inserm U1046, Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint-Eloi Teaching Hospital, Université Montpellier 1, Université Montpellier 2, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
authors.forename: G
authors.initials: G
authors.lastname: Chanques
authors.affiliation: EA 3409, Department of Anesthesiology and critical care medicine, Avicenne university hospital, Paris-13 university, AP-HP, 125, route de Stalingrad, 93009 Bobigny, France.
authors.forename: C
authors.initials: C
authors.lastname: Baillard
authors.affiliation: Unité Inserm U1046, Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint-Eloi Teaching Hospital, Université Montpellier 1, Université Montpellier 2, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France. Electronic address: s-jaber@chu-montpellier.fr.
authors.forename: S
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy / Q000628:therapy; D007442:Intubation, Intratracheal / Q000009:adverse effects; D009873:Operating Rooms; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods*; D018570:Risk Assessment
keywords: Bloc opératoire; Critically-ill; Grossesse; Obesity; Obésité; Operative room; Pregnancy; Preoxygenation; Préoxygénation; Réanimation