Tags

Type your tag names separated by a space and hit enter

New method of preoxygenation for orotracheal intubation in patients with hypoxaemic acute respiratory failure in the intensive care unit, non-invasive ventilation combined with apnoeic oxygenation by high flow nasal oxygen: the randomised OPTINIV study protocol.
BMJ Open. 2016 08 12; 6(8):e011298.BO

Abstract

INTRODUCTION

Tracheal intubation in the intensive care unit (ICU) is associated with severe life-threatening complications including severe hypoxaemia. Preoxygenation before intubation has been recommended in order to decrease such complications. Non-invasive ventilation (NIV)-assisted preoxygenation allows increased oxygen saturation during the intubation procedure, by applying a positive end-expiratory pressure (PEEP) to prevent alveolar derecruitment. However, the NIV mask has to be taken off after preoxygenation to allow the passage of the tube through the mouth. The patient with hypoxaemia does not receive oxygen during this period, at risk of major hypoxaemia. High-flow nasal cannula oxygen therapy (HFNC) has a potential for apnoeic oxygenation during the apnoea period following the preoxygenation with NIV. Whether application of HFNC combined with NIV is more effective at reducing oxygen desaturation during the intubation procedure compared with NIV alone for preoxygenation in patients with hypoxaemia in the ICU with acute respiratory failure remains to be established.

METHODS AND ANALYSIS

The HFNC combined to NIV for decreasing oxygen desaturation during the intubation procedure in patients with hypoxaemia in the ICU (OPTINIV) trial is an investigator-initiated monocentre randomised controlled two-arm trial with assessor-blinded outcome assessment. The OPTINIV trial randomises 50 patients with hypoxaemia requiring orotracheal intubation for acute respiratory failure to receive NIV (pressure support=10, PEEP=5, fractional inspired oxygen (FiO2)=100%) combined with HFNC (flow=60 L/min, FiO2=100%, interventional group) or NIV alone (reference group) for preoxygenation. The primary outcome is lowest oxygen saturation during the intubation procedure. Secondary outcomes are intubation-related complications, quality of preoxygenation and ICU mortality.

ETHICS AND DISSEMINATION

The study project has been approved by the appropriate ethics committee (CPP Sud-Méditerranée). Informed consent is required. If combined application of HFNC and NIV for preoxygenation of patients with hypoxaemia in the ICU proves superior to NIV preoxygenation, its use will become standard practice, thereby decreasing hypoxaemia during the intubation procedure and potential complications related to intubation.

TRIAL REGISTRATION NUMBER

NCT02530957.

Authors+Show Affiliations

Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, Montpellier, France INSERM U1046, Montpellier, France.Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 729 MISTEA, Montpellier, France.Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, Montpellier, France INSERM U1046, Montpellier, France.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27519921

Citation

Jaber, Samir, et al. "New Method of Preoxygenation for Orotracheal Intubation in Patients With Hypoxaemic Acute Respiratory Failure in the Intensive Care Unit, Non-invasive Ventilation Combined With Apnoeic Oxygenation By High Flow Nasal Oxygen: the Randomised OPTINIV Study Protocol." BMJ Open, vol. 6, no. 8, 2016, pp. e011298.
Jaber S, Molinari N, De Jong A. New method of preoxygenation for orotracheal intubation in patients with hypoxaemic acute respiratory failure in the intensive care unit, non-invasive ventilation combined with apnoeic oxygenation by high flow nasal oxygen: the randomised OPTINIV study protocol. BMJ Open. 2016;6(8):e011298.
Jaber, S., Molinari, N., & De Jong, A. (2016). New method of preoxygenation for orotracheal intubation in patients with hypoxaemic acute respiratory failure in the intensive care unit, non-invasive ventilation combined with apnoeic oxygenation by high flow nasal oxygen: the randomised OPTINIV study protocol. BMJ Open, 6(8), e011298. https://doi.org/10.1136/bmjopen-2016-011298
Jaber S, Molinari N, De Jong A. New Method of Preoxygenation for Orotracheal Intubation in Patients With Hypoxaemic Acute Respiratory Failure in the Intensive Care Unit, Non-invasive Ventilation Combined With Apnoeic Oxygenation By High Flow Nasal Oxygen: the Randomised OPTINIV Study Protocol. BMJ Open. 2016 08 12;6(8):e011298. PubMed PMID: 27519921.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New method of preoxygenation for orotracheal intubation in patients with hypoxaemic acute respiratory failure in the intensive care unit, non-invasive ventilation combined with apnoeic oxygenation by high flow nasal oxygen: the randomised OPTINIV study protocol. AU - Jaber,Samir, AU - Molinari,Nicolas, AU - De Jong,Audrey, Y1 - 2016/08/12/ PY - 2016/8/14/entrez PY - 2016/8/16/pubmed PY - 2017/12/6/medline SP - e011298 EP - e011298 JF - BMJ open JO - BMJ Open VL - 6 IS - 8 N2 - INTRODUCTION: Tracheal intubation in the intensive care unit (ICU) is associated with severe life-threatening complications including severe hypoxaemia. Preoxygenation before intubation has been recommended in order to decrease such complications. Non-invasive ventilation (NIV)-assisted preoxygenation allows increased oxygen saturation during the intubation procedure, by applying a positive end-expiratory pressure (PEEP) to prevent alveolar derecruitment. However, the NIV mask has to be taken off after preoxygenation to allow the passage of the tube through the mouth. The patient with hypoxaemia does not receive oxygen during this period, at risk of major hypoxaemia. High-flow nasal cannula oxygen therapy (HFNC) has a potential for apnoeic oxygenation during the apnoea period following the preoxygenation with NIV. Whether application of HFNC combined with NIV is more effective at reducing oxygen desaturation during the intubation procedure compared with NIV alone for preoxygenation in patients with hypoxaemia in the ICU with acute respiratory failure remains to be established. METHODS AND ANALYSIS: The HFNC combined to NIV for decreasing oxygen desaturation during the intubation procedure in patients with hypoxaemia in the ICU (OPTINIV) trial is an investigator-initiated monocentre randomised controlled two-arm trial with assessor-blinded outcome assessment. The OPTINIV trial randomises 50 patients with hypoxaemia requiring orotracheal intubation for acute respiratory failure to receive NIV (pressure support=10, PEEP=5, fractional inspired oxygen (FiO2)=100%) combined with HFNC (flow=60 L/min, FiO2=100%, interventional group) or NIV alone (reference group) for preoxygenation. The primary outcome is lowest oxygen saturation during the intubation procedure. Secondary outcomes are intubation-related complications, quality of preoxygenation and ICU mortality. ETHICS AND DISSEMINATION: The study project has been approved by the appropriate ethics committee (CPP Sud-Méditerranée). Informed consent is required. If combined application of HFNC and NIV for preoxygenation of patients with hypoxaemia in the ICU proves superior to NIV preoxygenation, its use will become standard practice, thereby decreasing hypoxaemia during the intubation procedure and potential complications related to intubation. TRIAL REGISTRATION NUMBER: NCT02530957. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/27519921/New_method_of_preoxygenation_for_orotracheal_intubation_in_patients_with_hypoxaemic_acute_respiratory_failure_in_the_intensive_care_unit_non_invasive_ventilation_combined_with_apnoeic_oxygenation_by_high_flow_nasal_oxygen:_the_randomised_OPTINIV_study_protocol_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=27519921 DB - PRIME DP - Unbound Medicine ER -