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Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia.
Crit Care Med. 2015 Mar; 43(3):574-83.CC

Abstract

OBJECTIVES

Tracheal intubation of ICU patients is frequently associated with severe hypoxemia. Although noninvasive ventilation reduces desaturation during intubation of severely hypoxemic patients, it does not allow for per-procedure oxygenation and has not been evaluated in mild-to-moderate hypoxemic patients for whom high-flow nasal cannula oxygen may be an alternative. We sought to compare pre- and per-procedure oxygenation with either a nonrebreathing bag reservoir facemask or a high-flow nasal cannula oxygen during tracheal intubation of ICU patients.

DESIGN

Prospective quasi-experimental before-after study (ClinicalTrials.gov: NCT01699880).

SETTING

University hospital medico-surgical ICU.

PATIENTS

All adult patients requiring tracheal intubation in the ICU were eligible.

INTERVENTIONS

In the control (before) period, preoxygenation was performed with a nonrebreathing bag reservoir facemask and in the change of practice (after) period, with high-flow nasal cannula oxygen.

MEASUREMENTS AND MAIN RESULTS

Primary outcome was median lowest SpO2 during intubation, and secondary outcomes were SpO2 after preoxygenation and number of patients with saturation less than 80%. One hundred one patients were included. Median lowest SpO2 during intubation were 94% (83-98.5) with the nonrebreathing bag reservoir facemask versus 100% (95-100) with high-flow nasal cannula oxygen (p < 0.0001). SpO2 values at the end of preoxygenation were higher with high-flow nasal cannula oxygen than with nonrebreathing bag reservoir facemask and were correlated with the lowest SpO2 reached during the intubation procedure (r = 0.38, p < 0.0001). Patients in the nonrebreathing bag reservoir facemask group experienced more episodes of severe hypoxemia (2% vs 14%, p = 0.03). In the multivariate analysis, preoxygenation with high-flow nasal cannula oxygen was an independent protective factor of the occurrence of severe hypoxemia (odds ratio, 0.146; 95% CI, 0.01-0.90; p = 0.037).

CONCLUSIONS

High-flow nasal cannula oxygen significantly improved preoxygenation and reduced prevalence of severe hypoxemia compared with nonrebreathing bag reservoir facemask. Its use could improve patient safety during intubation.

Authors+Show Affiliations

1Medico-Surgical Intensive Care Unit, Hôpital Louis Mourier, AP-HP, Colombes, France. 2Department of Epidemiology and Clinical Research, Hôpital Louis Mourier, AP-HP, Colombes, France. 3Institut National de la Santé et de la Recherche Médicale (INSERM), IAME, UMR 1137, F-75018, Paris, France. 4Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25479117

Citation

Miguel-Montanes, Romain, et al. "Use of High-flow Nasal Cannula Oxygen Therapy to Prevent Desaturation During Tracheal Intubation of Intensive Care Patients With Mild-to-moderate Hypoxemia." Critical Care Medicine, vol. 43, no. 3, 2015, pp. 574-83.
Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43(3):574-83.
Miguel-Montanes, R., Hajage, D., Messika, J., Bertrand, F., Gaudry, S., Rafat, C., Labbé, V., Dufour, N., Jean-Baptiste, S., Bedet, A., Dreyfuss, D., & Ricard, J. D. (2015). Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Critical Care Medicine, 43(3), 574-83. https://doi.org/10.1097/CCM.0000000000000743
Miguel-Montanes R, et al. Use of High-flow Nasal Cannula Oxygen Therapy to Prevent Desaturation During Tracheal Intubation of Intensive Care Patients With Mild-to-moderate Hypoxemia. Crit Care Med. 2015;43(3):574-83. PubMed PMID: 25479117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. AU - Miguel-Montanes,Romain, AU - Hajage,David, AU - Messika,Jonathan, AU - Bertrand,Fabrice, AU - Gaudry,Stéphane, AU - Rafat,Cédric, AU - Labbé,Vincent, AU - Dufour,Nicolas, AU - Jean-Baptiste,Sylvain, AU - Bedet,Alexandre, AU - Dreyfuss,Didier, AU - Ricard,Jean-Damien, PY - 2014/12/6/entrez PY - 2014/12/6/pubmed PY - 2015/4/22/medline SP - 574 EP - 83 JF - Critical care medicine JO - Crit Care Med VL - 43 IS - 3 N2 - OBJECTIVES: Tracheal intubation of ICU patients is frequently associated with severe hypoxemia. Although noninvasive ventilation reduces desaturation during intubation of severely hypoxemic patients, it does not allow for per-procedure oxygenation and has not been evaluated in mild-to-moderate hypoxemic patients for whom high-flow nasal cannula oxygen may be an alternative. We sought to compare pre- and per-procedure oxygenation with either a nonrebreathing bag reservoir facemask or a high-flow nasal cannula oxygen during tracheal intubation of ICU patients. DESIGN: Prospective quasi-experimental before-after study (ClinicalTrials.gov: NCT01699880). SETTING: University hospital medico-surgical ICU. PATIENTS: All adult patients requiring tracheal intubation in the ICU were eligible. INTERVENTIONS: In the control (before) period, preoxygenation was performed with a nonrebreathing bag reservoir facemask and in the change of practice (after) period, with high-flow nasal cannula oxygen. MEASUREMENTS AND MAIN RESULTS: Primary outcome was median lowest SpO2 during intubation, and secondary outcomes were SpO2 after preoxygenation and number of patients with saturation less than 80%. One hundred one patients were included. Median lowest SpO2 during intubation were 94% (83-98.5) with the nonrebreathing bag reservoir facemask versus 100% (95-100) with high-flow nasal cannula oxygen (p < 0.0001). SpO2 values at the end of preoxygenation were higher with high-flow nasal cannula oxygen than with nonrebreathing bag reservoir facemask and were correlated with the lowest SpO2 reached during the intubation procedure (r = 0.38, p < 0.0001). Patients in the nonrebreathing bag reservoir facemask group experienced more episodes of severe hypoxemia (2% vs 14%, p = 0.03). In the multivariate analysis, preoxygenation with high-flow nasal cannula oxygen was an independent protective factor of the occurrence of severe hypoxemia (odds ratio, 0.146; 95% CI, 0.01-0.90; p = 0.037). CONCLUSIONS: High-flow nasal cannula oxygen significantly improved preoxygenation and reduced prevalence of severe hypoxemia compared with nonrebreathing bag reservoir facemask. Its use could improve patient safety during intubation. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/25479117/Use_of_high_flow_nasal_cannula_oxygen_therapy_to_prevent_desaturation_during_tracheal_intubation_of_intensive_care_patients_with_mild_to_moderate_hypoxemia_ L2 - https://dx.doi.org/10.1097/CCM.0000000000000743 DB - PRIME DP - Unbound Medicine ER -