{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T05:28:27Z","timestamp":1794461307068,"version":"4.9.1"},"reference-count":14,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2020,11,16]],"date-time":"2020-11-16T00:00:00Z","timestamp":1605484800000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,10,7]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Apnoeic oxygenation is a process of delivering continuous oxygen through nasal cannula during direct laryngoscopy. The oxygen that is delivered through these nasal cannulas is either low flow or high flow. Although the effectiveness of apnoeic oxygenation has been shown through systematic reviews and randomised controlled trials, a comparison of high-flow versus low-flow oxygen delivery has not been tested through a superiority study design. In this study we propose to assess the effectiveness of giving low-flow oxygen with head side elevation versus high-flow oxygen with head side elevation against the usual practice of care in which no oxygen is provided during direct laryngoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This will be a three-arm study instituting a block randomisation technique with a sample size of 46 in each arm (see table 1). Due to the nature of the intervention, no blinding will be introduced. The primary outcomes will be lowest non-invasive oxygen saturation measurement during direct laryngoscopy and during the 2\u2009min after the placement of the tube and the first pass success rate. The intervention constitutes head side elevation up to 30\u00b0 for improving glottis visualisation together with low-flow or high-flow oxygen delivery through nasal cannula to increase safe apnoea time for participants undergoing endotracheal intubation. Primary analysis will be intention to treat.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study is approved by the Ethical Review Committee of Aga Khan University Hospital (2019-0726-2463). The project is an institution University Research Committee grant recipient 192\u2009002ER-PK. The results of the study will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations and emails. Further, the findings will be published in a highly accessed peer-reviewed medical journal and will be presented at both national and international conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Registry (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04242537\">NCT04242537<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-037964","type":"journal-article","created":{"date-parts":[[2020,11,16]],"date-time":"2020-11-16T16:21:33Z","timestamp":1605543693000},"page":"e037964","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Randomised controlled trial to assess the effectiveness of apnoeic oxygenation in adults using low-flow or high-flow nasal cannula with head side elevation versus usual care to prevent desaturation during endotracheal intubation in the emergency department (ApOxED): study protocol"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct04242537","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0954-1642","authenticated-orcid":false,"given":"Shahan","family":"Waheed","sequence":"first","affiliation":[{"name":"Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazir Najeeb","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Faisal","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salima Mansoor","family":"Kerai","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Raheem","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubaba","family":"Naeem","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,11,16]]},"reference":[{"key":"2025121220230551000_10.11.e037964.1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000233879.58720.87"},{"key":"2025121220230551000_10.11.e037964.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1205-6"},{"key":"2025121220230551000_10.11.e037964.3","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer504"},{"key":"2025121220230551000_10.11.e037964.4","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.jemermed.2010.02.014","article-title":"Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department","volume":"40","author":"Weingart","year":"2011","journal-title":"J Emerg Med"},{"key":"2025121220230551000_10.11.e037964.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2011.10.002"},{"key":"2025121220230551000_10.11.e037964.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.11.014"},{"key":"2025121220230551000_10.11.e037964.7","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/j.1365-2044.2007.05104.x","article-title":"Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation","volume":"62","author":"Baraka","year":"2007","journal-title":"Anaesthesia"},{"key":"2025121220230551000_10.11.e037964.8","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1213\/ANE.0000000000001564","article-title":"Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of buccal Rae tube oxygen administration","volume":"124","author":"Heard","year":"2017","journal-title":"Anesth Analg"},{"key":"2025121220230551000_10.11.e037964.9","first-page":"454","article-title":"Role of nasopharyngeal oxygen insufflation on haemoglobin desaturation following preoxygenation","volume":"25","author":"Jain","year":"2009","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025121220230551000_10.11.e037964.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2009.05.006"},{"key":"2025121220230551000_10.11.e037964.11","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1007\/s00134-016-4588-9","article-title":"Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial","volume":"42","author":"Jaber","year":"2016","journal-title":"Intensive Care Med"},{"key":"2025121220230551000_10.11.e037964.12","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12923"},{"key":"2025121220230551000_10.11.e037964.13","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.annemergmed.2017.05.001","article-title":"Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis","volume":"70","author":"Oliveira J E Silva","year":"2017","journal-title":"Ann Emerg Med"},{"key":"2025121220230551000_10.11.e037964.14","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-037964","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T04:23:14Z","timestamp":1765599794000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-037964"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":14,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,16]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/bmjopen-2020-037964"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-037964","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2020-037964.supp1","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2020-037964.supp2","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11]]}}}