What is the recommended oxygen administration protocol for actively seizing patients?

Oxygen Administration Protocol for Actively Seizing Patients

For actively seizing patients, high-concentration oxygen should be administered via a non-rebreather mask at 15 L/min as the preferred method of oxygen delivery until reliable pulse oximetry monitoring has been established. 1

Initial Oxygen Administration

• First-line approach: Use a high-concentration reservoir (non-rebreather) mask at 15 L/min
• Target oxygen saturation: 94-98% 1, 2
• Monitoring: Establish reliable pulse oximetry as soon as possible

Rationale for High-Flow Oxygen

The British Thoracic Society guidelines recommend high-concentration oxygen delivery via reservoir mask at 15 L/min as the preferred means for delivering oxygen to critically ill patients, including those who are actively seizing 1. This approach ensures maximum oxygen delivery during a period when the patient's respiratory pattern may be compromised due to seizure activity.

Device Selection Based on Patient Status

During Active Seizure

• Primary device: Non-rebreather mask at 15 L/min
• Alternative if non-rebreather unavailable: Simple face mask at 10 L/min

Post-Seizure (Once Stabilized)

• If patient remains hypoxic: Continue non-rebreather mask at 15 L/min
• If oxygenation improves: Consider transitioning to nasal cannula at 2-6 L/min to maintain target saturation of 94-98% 1
• For patients with known COPD: Use 24% or 28% Venturi mask or nasal cannula at 1-2 L/min with target saturation of 88-92% 1

Special Considerations

Patients with Risk of Hypercapnic Respiratory Failure

• For patients with known COPD or other conditions predisposing to hypercapnic respiratory failure:
  • Use 24% or 28% Venturi mask or nasal cannula at 1-2 L/min
  • Target lower oxygen saturation of 88-92% 1
  • Monitor closely for signs of worsening respiratory status

Pediatric Patients

• For pediatric patients who are actively seizing:
  • Use 100% oxygen during resuscitation 1
  • Once circulation is restored, titrate oxygen to maintain saturation ≥94% 1
  • For infants and small children, ensure appropriate sizing of masks and equipment

Technique Optimization

Non-Rebreather Mask Application

• Ensure proper mask seal to face
• Maintain reservoir bag inflation at all times
• Set flow rate to 15 L/min 1

If Bag-Valve-Mask Ventilation Becomes Necessary

• Two-person technique is preferred for optimal delivery 1
• One person maintains airway and mask seal while second person compresses the bag
• Deliver each breath over approximately 1 second to minimize gastric inflation 1
• Ensure visible chest rise with each ventilation 1

Pitfalls to Avoid

1. Inadequate flow rates: Flow rates below 5 L/min with simple face masks can cause carbon dioxide rebreathing 1

2. Mask leaks: Even with flush rate oxygen, bag-valve-mask performance is significantly compromised with mask leaks 3, 4

3. Delayed escalation: Don't delay transitioning to more advanced airway management if the patient's condition deteriorates 2

4. Overreliance on standard flow rates: Research shows that during respiratory distress, standard flow rates may not deliver expected oxygen concentrations 5

5. Assuming all masks perform equally: Different oxygen delivery devices provide significantly different FiO₂ levels at the same flow rates 6

By following this protocol, you can ensure optimal oxygenation for actively seizing patients while minimizing risks of both hypoxemia and potential complications from inappropriate oxygen administration.