Noninvasive Ventilation Improves Preoxygenation before Intubation of Hypoxic Patients

TLDR

Critically ill patients are at high risk of oxyhemoglobin desaturation during intubation. The study aimed to determine whether noninvasive ventilation (NIV) as a preoxygenation strategy reduces arterial oxyhemoglobin desaturation compared with conventional preoxygenation in hypoxemic, critically ill patients. In a prospective randomized trial across two ICUs, patients received 3‑minute preoxygenation either with a nonrebreather bag‑valve mask (control) or pressure‑support ventilation via an ICU ventilator through a face mask (NIV). NIV significantly increased SpO₂ at the end of preoxygenation (98 ± 2 % vs 93 ± 6 %), during intubation (93 ± 8 % vs 81 ± 15 %) and five minutes post‑intubation (98 ± 2 % vs 94 ± 6 %), reduced the proportion of patients with SpO₂ < 80 % (7 % vs 46 %), and did not increase regurgitation or new infiltrates.

Abstract

Rationale: Critically ill patients are predisposed to oxyhemoglobin desaturation during intubation.Objectives: To find out whether noninvasive ventilation (NIV), as a preoxygenation method, is more effective at reducing arterial oxyhemoglobin desaturation than usual preoxygenation during orotracheal intubation in hypoxemic, critically ill patients.Methods: Prospective randomized study performed in two surgical/medical intensive care units (ICUs). Preoxygenation was performed, before a rapid sequence intubation, for a 3-min period using a nonrebreather bag-valve mask (control group) or pressure support ventilation delivered by an ICU ventilator through a face mask (NIV group) according to the randomization.Measurements and Main Results: The control (n = 26) and NIV (n = 27) groups were similar in terms of age, disease severity, diagnosis at admission, and pulse oxymetry values (SpO2) before preoxygenation. At the end of preoxygenation, SpO2 was higher in the NIV group as compared with the control group (98 ± 2 vs. 93 ± 6%, p < 0.001). During the intubation procedure, the lower SpO2 values were observed in the control group (81 ± 15 vs. 93 ± 8%, p < 0.001). Twelve (46%) patients in the control group and two (7%) in the NIV group had an SpO2 below 80% (p < 0.01). Five minutes after intubation, SpO2 values were still better in the NIV group as compared with the control group (98 ± 2 vs. 94 ± 6%, p < 0.01). Regurgitations (n = 3; 6%) and new infiltrates on post-procedure chest X ray (n = 4; 8%) were observed with no significant difference between groups.Conclusion: For the intubation of hypoxemic patients, preoxygenation using NIV is more effective at reducing arterial oxyhemoglobin desaturation than the usual method.