This video is from Dr Jim DuCanto, a good friend of PHARM and FOAMEd. It demonstrates the use of nasal oxygenation with positive pressure using an Oxylator device, whilst allowing free access to the oropharynx for the transoesophageal echocardiogram to be performed.
How could this be helpful? Well say you need to intubate someone who looks to be a difficult airway so you want to perform an awake intubation. Say this patient is needing CPAP or BiPAP via mask to maintain adequate oxygenation, right? Problem is when you remove the mask to intubate, even with spontaneous respirations, oxygenation starts to fail, right? You can try high flow nasal cannula but sometimes thats not enough. THe small nasal mask..or even a small paediatric face mask that will accomodate an adult nasal area allows you to connect up an Oxylator or ventilator and further enhance your ability to positive pressure oxygenate and even ventilate!
References:
Bronchoscopy during non invasive mechanical ventilation
Description of bronchoscopy during nasal mask non invasive ventilation
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
OK, I can see a use for this. Question – is the oxylator (or similar) available here in Oz/NZ and affordable?
Or can one ‘get by’ with a small paediatric mask as nasal CPAP?
Intriguing….
Oxylator available next year I believe in Oz.
You could use your anaesthetic machine vent or even the Oxylog 3000 CPAP mode or on PCV + PS mode if you want to ventilate as well…and a small face mask. The straps help if you can get em.
Tim, I think you could use any number of methods with a pediatric mask over the nose. The anesthesia machine could serve, but it is limited to a 10 lpm fresh gas flow, although PEEP could potentially be applied through the system. The interesting factor here is flow of oxygen, not necessarily just the PEEP/pressure. What is the inspiratory flow of the Oxylog? The Oxylator will provide 30 lpm on automatic mode as long as you supply it with gas and an open airway.
Cost is less than a thousand USD (850-950).
thanks Jim! Your nasal Oxylator video is very popular viewing!
Oxylog max insp flow rates = 39-100L/min depending on PSI
Click to access oxylog_3000_plus_data_9066205_en.pdf
Yep, thanks Jim – “trailling a coat” there (think foxhounds for the non-UK types) and you filled in the gaps – thanks.
Oxylator it is!
Hello Dr Ducanto,
What propofol dose infusion do you use in this case? Did you use only propofol?
Nice work, hopefully, more videos like this.
Best regards for all.
Roberto Sciacca
Asuncion, Paraguay
Hi Roberto,
I use a syringe pump that delivers in mcg/kg/min, and I minimize the narcotics (I don’t think I used any narcotics during this sedation). I set the syringe pump to 200-300 mcg/kg/min to allow the drug to accumulate enough to be effective, then the infusion rate is decreased to 75 -100 mcg/kg/min.
Dr. Ducanto,
Thank you for the tips.
Roberto