Is it time for apnoeic oxygenation during endotracheal intubation in critically ill patients?

Endotracheal intubation is a potentially hazardous procedure performed in the intensive care unit. A combination of cardiorespiratory compromise and the increased metabolic demands of critical illness can lead to the rapid onset of hypoxia with apnoea. Critical oxygen desaturation (which may be defined as arterial oxygen desaturation to less than 70%) places patients at risk of considerable morbidity. Complications may include haemodynamic collapse, arrhythmias and hypoxic brain injury. Existing research indicates that desaturation to <85% may occur in as little as 23 seconds in critically ill patients. This is 25 times as fast as desaturation described in healthy adults. Given that estimates of the incidence of difficult intubation in ICU patients can be as high as 20%, and that 10% of ICU intubations needed at least 10 minutes, any technique that could potentially delay the onset of desaturation would be of considerable benefit.