Apneic Oxygenation


Clinical Indications:


  • Pre-oxygenation of the RSI candidate.




  1. Position the patient in a semi-recumbent position (head-up greater than 20⁰).
  2. Place a nasal cannula in the patient’s nares and connect to an oxygen regulator.
  3. Place a non-rebreather or CPAP device at 5 cm H2O over the nasal cannula and connect to a second oxygen regulator.
  4. If the patient is not saturating above 90%, remove non-rebreather or CPAP and provide ventilations utilizing a bag valve mask.
  5. Administer sedative.
  6. Position the patient into the sniffing position and manually open the airway utilizing two hands.
  7. Attempt to maintain an oxygen saturation greater than 95%.
  8. Remove the nasal cannula if unable to get a high quality seal with the CPAP or bag valve mask.
  9. Administer paralytic.
  10. Remove CPAP, non-rebreather mask, or bag valve mask and leave the nasal cannula flowing at 15 liters per minute.
  11. Intubate the trachea and confirm tube placement.
  12. Remove the nasal cannula.




  • Apneic oxygenation can still benefit the trauma patient; keep the patient supine with spinal precautions in place and do not use CPAP.