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Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation

Efficacité de la préoxygénation utilisant les techniques de respiration en volume courant et de respiration profonde avec et sans expiration maximale préalable

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We evaluated the influence of prior maximal exhalation on preoxygenation in 15 adult volunteers using tidal volume breathing (TVB) for five minutes and deep breathing (DB) for two minutes with and without prior maximal exhalation.


Inspired and end-tidal oxygen, nitrogen and carbon dioxide were monitored continuously and recorded during room air breathing and at 30-sec intervals during 100% oxygen TVB or DB (rate of 8 breaths·min−1).


Tidal volume breathing with prior maximal exhalation resulted in an end-tidal oxygen concentration (ETO2) slightly higher (P = 0.028) at 0.5 and 1.0 min as compared with TVB without prior maximal exhalation at the same time periods. Regardless of whether TVB was preceded by maximal exhalation or not, 2.5 min was required to reach a mean ETO2 value of 90% or higher. With DB, there were no differences in ETO2 values at any time period and 1.5 min was required to reach an ETO2 of 90% or greater, with or without prior maximal exhalation.


Maximal exhalation prior to TVB slightly steepens the initial rise in ETO2 during the first minute, but confers no real benefit if maximal preoxygenation is the goal. Maximal exhalation prior to DB has no added value in enhancing preoxygenation.



Nous avons évalué l’influence d’une expiration maximale préalable sur la préoxygénation chez 15 volontaires adultes utilisant la respiration en volume courant (TVB) durant cinq minutes et la respiration profonde (DB) pendant deux minutes, avec et sans expiration maximale préalable.


Les concentrations inspirées et expirées d’oxygène, d’azote et de dioxyde de carbone ont été mesurées continuellement et enregistrées aux 30 sec durant la respiration à l’air ambiant durant une TVB ou une DB d’oxygène à 100% (fréquence respiratoire de 8·min−1).


La respiration en volume courant avec une expiration maximale préalable a permis d’obtenir une concentration d’oxygène expiré (ETO2) légèrement plus élevée (P = 0,028) à 0,5 et 1,0 min comparée à une TVB sans expiration maximale préalable aux mêmes temps. Afin d’atteindre une valeur moyenne d’ETO2 de 90 % ou plus, 2,5 minutes étaient nécessaires, avec ou sans expiration maximale préalable. Avec la DB, une différence dans les valeurs d’ETO2 n’a été observée à aucune période de temps, et 1,5 min ont été nécessaires pour atteindre une ETO2 de 90% ou plus, avec ou sans expiration maximale préalable.


Une expiration maximale préalable à une TVB accentue légèrement la montée initiale d’ETO2 durant la première minute, mais n’apporte pas de bénéfice réel si la préoxygénation maximale est visée. Une expiration maximale préalable à une DB n’a pas de valeur ajoutée quant à l’amélioration de la préoxygénation.


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Author information

Correspondence to Usharani Nimmagadda or M. Ramez Salem or Ninos J. Joseph or Istvan Miko.

Additional information

This study was supported entirely with funds from the Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.

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Nimmagadda, U., Salem, M.R., Joseph, N.J. et al. Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation. Can J Anesth 54, 448–452 (2007). https://doi.org/10.1007/BF03022030

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  • Functional Residual Capacity
  • Deep Breathing
  • Volume Courant
  • Tidal Volume Breathing
  • Maximal Exhalation