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[Effect of preoxygenation and apnoeic oxygenation during intubation in the critically ill patients: a network Meta-analysis].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Oct; 31(10):1236-1241.ZW

Abstract

OBJECTIVE

To systematic review the effect of preoxygenation (PreOx) and apnoeic oxygenation (ApOx) during intubation in the critically ill patients by network Meta-analysis.

METHODS

The PubMed, Embase, the Cochrane Library, CNKI and Wanfang Data were searched by computer to collect randomized controlled trials (RCT) of PreOx and ApOx techniques in the intensive care unit (ICU) from inception to January 30th, 2019. PreOx techniques (p) included nasal cannula (NC), high flow nasal cannula (HFNC), bag valve mask (BVM), bi-level positive airway pressure (BiPAP), non-rebreather mask (NRM) and non-invasive ventilation (NIV), etc.; ApOx technique (a) referred to HFNC. Experimental group strategy was PreOx combined with ApOx, and control group strategy was PreOx alone. The outcomes were as follows: the lowest value of pulse oximetry (SpO2) during the intubation procedure, the incidence of severe desaturations (SpO2< 0.80), and severe intubation-related complications [including SpO2< 0.80, systolic blood pressure < 80 mmHg (1 mmHg = 0.133 kPa), vasopressor 30% dose increment, cardiac arrest and death]. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistic analysis was performed by RevMan 5.3 software, Stata 15.1 software and WinBUGS 1.4.3 software.

RESULTS

A total of 7 RCTs involving 796 patients were included. Meta-analysis showed that, compared with the control group, the lowest SpO2 in the experimental group was significantly increased [mean difference (MD) = 1.42, 95% confidence interval (95%CI) was 0.60 to 2.25, P = 0.000 7], the incidence of severe complications was significantly decreased [odds ratio (OR) = 0.54, 95%CI was 0.32 to 0.92, P = 0.02], but the incidence of SpO2 < 0.80 did not improve significantly (OR = 0.65, 95%CI was 0.40 to 1.05, P = 0.08). The network Meta-analysis showed that, compared with non-pressure mask (NPM)p, (HFNC+NIV)p+HFNCa (OR = 51.20, 95%CI was 2.06 to 3 518.68) and NIVp (OR = 5.80, 95%CI was 1.25 to 34.70) had a significant reduction in the incidence of SpO2 < 0.80 (both P < 0.05). There were no significant differences in the incidence of severe complications during intubation among (HFNC+NIV)p+HFNCa, HFNCp+HFNCa, NIVp and NPMp. The occurrence rate of SpO2 < 0.80 and severe complications using different oxygenation techniques decreased sequentially in NPMp, HFNCp+HFNCa, NIVp and (HFNC+NIV)p+HFNCa.

CONCLUSIONS

(HFNC+NIV)p+HFNCa should be of a priority choice for critically ill patients during intubation.

Authors+Show Affiliations

Department of Intensive Care Unit, the First People's Hospital of Lianyungang City, Lianyungang 222002, Jiangsu, China. Corresponding author: Liu Kexi, Email: 18961327791@163.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

chi

PubMed ID

31771721

Citation

Cao, Lijuan, et al. "[Effect of Preoxygenation and Apnoeic Oxygenation During Intubation in the Critically Ill Patients: a Network Meta-analysis]." Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, vol. 31, no. 10, 2019, pp. 1236-1241.
Cao L, Zheng H, Xie Y, et al. [Effect of preoxygenation and apnoeic oxygenation during intubation in the critically ill patients: a network Meta-analysis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(10):1236-1241.
Cao, L., Zheng, H., Xie, Y., Liu, S., & Liu, K. (2019). [Effect of preoxygenation and apnoeic oxygenation during intubation in the critically ill patients: a network Meta-analysis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 31(10), 1236-1241. https://doi.org/10.3760/cma.j.issn.2095-4352.2019.10.011
Cao L, et al. [Effect of Preoxygenation and Apnoeic Oxygenation During Intubation in the Critically Ill Patients: a Network Meta-analysis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(10):1236-1241. PubMed PMID: 31771721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Effect of preoxygenation and apnoeic oxygenation during intubation in the critically ill patients: a network Meta-analysis]. AU - Cao,Lijuan, AU - Zheng,Hui, AU - Xie,Yongpeng, AU - Liu,Suxia, AU - Liu,Kexi, PY - 2019/11/28/entrez PY - 2019/11/28/pubmed PY - 2019/12/21/medline SP - 1236 EP - 1241 JF - Zhonghua wei zhong bing ji jiu yi xue JO - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue VL - 31 IS - 10 N2 - OBJECTIVE: To systematic review the effect of preoxygenation (PreOx) and apnoeic oxygenation (ApOx) during intubation in the critically ill patients by network Meta-analysis. METHODS: The PubMed, Embase, the Cochrane Library, CNKI and Wanfang Data were searched by computer to collect randomized controlled trials (RCT) of PreOx and ApOx techniques in the intensive care unit (ICU) from inception to January 30th, 2019. PreOx techniques (p) included nasal cannula (NC), high flow nasal cannula (HFNC), bag valve mask (BVM), bi-level positive airway pressure (BiPAP), non-rebreather mask (NRM) and non-invasive ventilation (NIV), etc.; ApOx technique (a) referred to HFNC. Experimental group strategy was PreOx combined with ApOx, and control group strategy was PreOx alone. The outcomes were as follows: the lowest value of pulse oximetry (SpO2) during the intubation procedure, the incidence of severe desaturations (SpO2< 0.80), and severe intubation-related complications [including SpO2< 0.80, systolic blood pressure < 80 mmHg (1 mmHg = 0.133 kPa), vasopressor 30% dose increment, cardiac arrest and death]. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistic analysis was performed by RevMan 5.3 software, Stata 15.1 software and WinBUGS 1.4.3 software. RESULTS: A total of 7 RCTs involving 796 patients were included. Meta-analysis showed that, compared with the control group, the lowest SpO2 in the experimental group was significantly increased [mean difference (MD) = 1.42, 95% confidence interval (95%CI) was 0.60 to 2.25, P = 0.000 7], the incidence of severe complications was significantly decreased [odds ratio (OR) = 0.54, 95%CI was 0.32 to 0.92, P = 0.02], but the incidence of SpO2 < 0.80 did not improve significantly (OR = 0.65, 95%CI was 0.40 to 1.05, P = 0.08). The network Meta-analysis showed that, compared with non-pressure mask (NPM)p, (HFNC+NIV)p+HFNCa (OR = 51.20, 95%CI was 2.06 to 3 518.68) and NIVp (OR = 5.80, 95%CI was 1.25 to 34.70) had a significant reduction in the incidence of SpO2 < 0.80 (both P < 0.05). There were no significant differences in the incidence of severe complications during intubation among (HFNC+NIV)p+HFNCa, HFNCp+HFNCa, NIVp and NPMp. The occurrence rate of SpO2 < 0.80 and severe complications using different oxygenation techniques decreased sequentially in NPMp, HFNCp+HFNCa, NIVp and (HFNC+NIV)p+HFNCa. CONCLUSIONS: (HFNC+NIV)p+HFNCa should be of a priority choice for critically ill patients during intubation. SN - 2095-4352 UR - https://www.unboundmedicine.com/medline/citation/31771721/[Effect_of_preoxygenation_and_apnoeic_oxygenation_during_intubation_in_the_critically_ill_patients:_a_network_Meta_analysis]_ L2 - https://medlineplus.gov/respiratoryfailure.html DB - PRIME DP - Unbound Medicine ER -