{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:25:44Z","timestamp":1772252744606,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"publisher","award":["491454339"],"award-info":[{"award-number":["491454339"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: In a cannot-ventilate-cannot-intubate situation, careful preoxygenation with high FiO2 allowing subsequent apneic oxygenation can be life-saving. The best position for an oxygen supply line within the human airway at which oxygen insufflation is more effective than standard preoxygenation with a face mask is unknown. Methods: In this experimental study, we compared the effectiveness of preoxygenation by placing an oxygen cannula at the nose entrance, through the nose at the soft palatine, or at the base of the tongue; as a control we used ambient air. We connected a fully preoxygenated test lung on one side to an oximeter with a flow rate of 200 mL\/min simulating the oxygen consumption of a normal adult on the other side of the trachea of an anatomically correctly shaped airway manikin over a 20 min observation period five times for each cannula placement in a random order. Results: The oxygen percentage in the test lung dropped from 100% in all groups to 53 \u00b1 1% in the ambient air control group, to 87 \u00b1 2% in the nasal cannula group, and to 96 \u00b1 2% in the soft palatine group; it remained at 99 \u00b1 1% in the base of the tongue group (p = 0.003 for the soft palatine vs. base of the tongue and p &lt; 0.001 for all other groups). Conclusions: When simulating apneic oxygenation in a preoxygenated manikin, oxygen insufflation at the base of the tongue kept the oxygen percentage at baseline values of 99%, demonstrating a complete block of ambient air flowing into the airway of the manikin. Oxygen insufflation at the soft palatine or insufflation via a nasal cannula were less effective regarding this effect.<\/jats:p>","DOI":"10.3390\/jcm11226809","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T06:02:29Z","timestamp":1668751349000},"page":"6809","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Identification of the Optimal Position of a Nasal Oxygen Cannula for Apneic Oxygenation: A Technical Simulation"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5800-6665","authenticated-orcid":false,"given":"Wolfgang","family":"Wetsch","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany"},{"name":"Department of Anesthesiology and Intensive Care, German Armed Forces Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Herff","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8000-8931","authenticated-orcid":false,"given":"Bernd","family":"B\u00f6ttiger","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volker","family":"Wenzel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Klinikum Friedrichshafen, 88048 Friedrichshafen, Germany"},{"name":"Department of Anesthesiology, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7380-4013","authenticated-orcid":false,"given":"Holger","family":"Herff","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany"},{"name":"Department of Anesthesiology, PAN Clinic, 50667 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s00101-010-1782-y","article-title":"Death due to no airway","volume":"59","author":"Russo","year":"2010","journal-title":"Anaesthesist"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1513\/AnnalsATS.201802-118OC","article-title":"Risk factors for and prediction of hypoxemia during tracheal intubation of critically ill adults","volume":"15","author":"McKown","year":"2018","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jemermed.2014.06.061","article-title":"A Dual-Use Laryngoscope to Facilitate Apneic Oxygenation","volume":"48","author":"Mitterlechner","year":"2014","journal-title":"J. Emerg. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Herff, H., Wetsch, W.A., Finke, S., Dusse, F., Mitterlechner, T., Paal, P., Wenzel, V., and Schroeder, D.C. (2021). Oxygenation laryngoscope vs. nasal standard and nasal high flow oxygenation in a technical simulation of apnoeic oxygenation. BMC Emerg. Med., 21.","DOI":"10.1186\/s12873-021-00407-5"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/2045-9912.323536","article-title":"A special oropharyngeal oxygenation device to facilitate apneic oxygenation in comparison to high flow oxygenation devices","volume":"12","author":"Wetsch","year":"2022","journal-title":"Med. Gas. Res."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wetsch, W.A., Herff, H., Schroeder, D.C., Sander, D., B\u00f6ttiger, B.W., and Finke, S.R. (2021). Efficiency of different flows for apneic oxygenation when using high flow nasal oxygen application\u2014A technical simulation. BMC Anesthesiol., 21.","DOI":"10.1186\/s12871-021-01461-z"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Schroeder, D.C., Wetsch, W.A., Finke, S.R., Dusse, F., B\u00f6ttiger, B.W., and Herff, H. (2020). Apneic laryngeal oxygenation during elective fiberoptic intubation\u2014A technical simulation. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-01216-2"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s00101-010-1711-0","article-title":"A ventilatory mass flow during apnea: Investigations on quantification","volume":"59","author":"Rudlof","year":"2010","journal-title":"Anaesthesist"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1177\/0310057X9802600509","article-title":"A comparison of the T-piece, Venturi T-piece T-bag for emergence with the laryngeal mask","volume":"25","author":"Poh","year":"1998","journal-title":"Anesth. Intensive Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/anae.13799","article-title":"A randomised controlled trial comparing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) preoxygenation with facemask preoxygenation in patients undergoing rapid sequence induction of anaesthesia","volume":"72","author":"Mir","year":"2017","journal-title":"Anaesthesia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/anae.14215","article-title":"Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) vs. facemask breathing pre-oxygenation for rapid sequence induction in adults: A prospective randomised non-blinded clinical trial","volume":"73","author":"Lodenius","year":"2018","journal-title":"Anaesthesia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16325","DOI":"10.1038\/s41598-022-20717-3","article-title":"Role of modified nasopharyngeal oxygen therapy in apnoeic oxygenation under general anaesthesia: A single centre, randomized controlled clinical study","volume":"12","author":"Geng","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1055\/s-2007-996487","article-title":"Apnoeic oxygenation in Boerhaave syndrome","volume":"30","author":"Biedler","year":"1995","journal-title":"Anasthesiol. Intensiv. Notf. Schmerzther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1038\/168830a0","article-title":"Diffusion respiration in man","volume":"168","author":"Enghoff","year":"1951","journal-title":"Nature"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1055\/s-2007-996723","article-title":"Oxygen supply despite respiratory arrest","volume":"29","author":"Zander","year":"1994","journal-title":"Anasthesiol. Intensivmed. Notfallmed. Schmerzther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/MAT.0b013e3181c4e935","article-title":"Alveolar accumulation of nitrogen druing apneic oxygenation with arteriovenous carbon dioxide removal","volume":"65","author":"Nielsen","year":"2010","journal-title":"ASAIO J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/anae.13451","article-title":"Oxygenating laryngoscopy","volume":"71","author":"Downing","year":"2016","journal-title":"Anaesthesia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"404","DOI":"10.4103\/ija.IJA_86_17","article-title":"A randomized comparative study of Miller laryngoscope blade versus Oxiport\u00ae Miller laryngoscopeblade for neonatal and infant intuabtions","volume":"61","author":"Dias","year":"2017","journal-title":"Indian J. Anesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/22\/6809\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:20:37Z","timestamp":1760145637000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/22\/6809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,17]]},"references-count":18,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jcm11226809"],"URL":"https:\/\/doi.org\/10.3390\/jcm11226809","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202211.0172.v1","asserted-by":"object"}]},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,17]]}}}