Rhys S Holyoak1, Thomas M Melhuish2, Ruan Vlok3, M Binks2, Leigh D White4. 1. School of Medicine, University of Wollongong, NSW, Australia. 2. Wagga Wagga Rural Referral Hospital, NSW, Australia; Faculty of Medicine, University of New South Wales, NSW, Australia. 3. Wagga Wagga Rural Referral Hospital, NSW, Australia; University of Notre Dame Australia, School of Medicine Sydney, Australia. 4. School of Medicine, University of Wollongong, NSW, Australia; Wagga Wagga Rural Referral Hospital, NSW, Australia. Electronic address: lw844@uowmail.edu.au.
Abstract
PURPOSE: To determine whether or not apnoeic oxygenation reduces the incidence of hypoxaemia during endotracheal intubation. MATERIALS AND METHODS: A systematic search of six databases for all relevant studies until November 2016 was performed. All study designs using apnoeic oxygenation during intubation were eligible for inclusion. All studies were assessed for level of evidence and risk of bias. A meta-analysis was performed on all data using Revman 5.3. RESULTS: Seventeen studies including 2422 patients were retrieved. Overall there was a significant reduction in the incidence of desaturation (RR=0.65; p<0.00001), critical desaturation (RR=0.61, p=0.002) and safe apnoea time (WMD=1.73min, p<0.00001). There was no significant difference in mortality (RR=0.77, p=0.08). CONCLUSIONS: In patients whom are being intubated for any indication other than respiratory failure, apnoeic oxygenation at any flow rate 15L or greater is likely to reduce their incidence of desaturation (<90%) and critical desaturation (<80%). However, further high quality RCTs are required given the high degree of heterogeneity in many of the outcomes and subgroup analyses.
PURPOSE: To determine whether or not apnoeic oxygenation reduces the incidence of hypoxaemia during endotracheal intubation. MATERIALS AND METHODS: A systematic search of six databases for all relevant studies until November 2016 was performed. All study designs using apnoeic oxygenation during intubation were eligible for inclusion. All studies were assessed for level of evidence and risk of bias. A meta-analysis was performed on all data using Revman 5.3. RESULTS: Seventeen studies including 2422 patients were retrieved. Overall there was a significant reduction in the incidence of desaturation (RR=0.65; p<0.00001), critical desaturation (RR=0.61, p=0.002) and safe apnoea time (WMD=1.73min, p<0.00001). There was no significant difference in mortality (RR=0.77, p=0.08). CONCLUSIONS: In patients whom are being intubated for any indication other than respiratory failure, apnoeic oxygenation at any flow rate 15L or greater is likely to reduce their incidence of desaturation (<90%) and critical desaturation (<80%). However, further high quality RCTs are required given the high degree of heterogeneity in many of the outcomes and subgroup analyses.
Authors: Luca Cabrini; Giovanni Landoni; Martina Baiardo Redaelli; Omar Saleh; Carmine D Votta; Evgeny Fominskiy; Alessandro Putzu; Cézar Daniel Snak de Souza; Massimo Antonelli; Rinaldo Bellomo; Paolo Pelosi; Alberto Zangrillo Journal: Crit Care Date: 2018-01-20 Impact factor: 9.097
Authors: Shane George; Susan Humphreys; Tara Williams; Ben Gelbart; Arjun Chavan; Katie Rasmussen; Anusha Ganeshalingham; Simon Erickson; Subodh Suhas Ganu; Nitesh Singhal; Kelly Foster; Brenda Gannon; Kristen Gibbons; Luregn J Schlapbach; Marino Festa; Stuart Dalziel; Andreas Schibler Journal: BMJ Open Date: 2019-02-20 Impact factor: 2.692