[Effectiveness of preoxygenation using the head-up position and noninvasive ventilation to reduce hypoxaemia during intubation].

OBJECTIVE: The purpose of this article was to present an update of the preoxygenation management in morbidly obese adults, parturient women and hypoxemic critically-ill patients. DATA SOURCES: All references obtained from the medical database Medline related to the area and more specifically during the last five years were reviewed. DATA SYNTHESIS: Preoxygenation decreases the risk of hypoxia and should be optimized when the standard technique appears to be less effective as in morbidly obese adults, parturient women and critically-ill patients. The head-up position and noninvasive ventilation may be useful during preoxygenation probably because of the increase of ventilation and alveolar recruitment. The effectiveness of preoxygenation (when defined as the duration of the desaturation safety period) is enhanced in the head-up position as compared to supine position in the obese patient but not in parturient women. Noninvasive ventilation improves preoxygenation in the hypoxemic critically-ill patient but not in the obese patient. Neither the head-up position nor the noninvasive ventilation improve preoxygenation in parturient women.
CONCLUSION: Further studies are required to investigate other methods attempting to improve preoxygenation and prevent hypoxemia during intubation.