Vincenzo Russotto1, Andrea Cortegiani2, Santi Maurizio Raineri2, Cesare Gregoretti2, Antonino Giarratano2. 1. Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del vespro 129, 90127 Palermo, Italy. Electronic address: vinrussotto@gmail.com. 2. Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del vespro 129, 90127 Palermo, Italy.
Abstract
PURPOSE: To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation. METHODS: We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. RESULTS: Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients). Three of these studies investigated high-flow nasal cannula (HFNC) for ApOx while standard nasal cannula was used in one. Globally, ApOx was associated with higher minimum SpO2 value compared to those receiving ETI without ApOx (mean difference 2.31%, 95% CI 0.42 to 4.20, p=0.02, I2=0%) but there were not significant differences between groups in severe hypoxemia and intubation related - complications. Concerning other techniques, noninvasive ventilation (NIV) was compared to bag-valve mask in only one RCT and it reduced the degree of desaturation. CONCLUSIONS: ApOx was significantly associated with higher minimum SpO2 registered during the intubation procedure. Further studies are needed to increase the number of included patients and demonstrate the benefit of ApOx and of other respiratory support methods (e.g. NIV, HFNC).
PURPOSE: To evaluate which respiratory support method for critically illpatients undergoing endotracheal intubation (ETI) is associated with less desaturation. METHODS: We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. RESULTS: Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically illpatients undergoing intubation (4 RCTs, 358 patients). Three of these studies investigated high-flow nasal cannula (HFNC) for ApOx while standard nasal cannula was used in one. Globally, ApOx was associated with higher minimum SpO2 value compared to those receiving ETI without ApOx (mean difference 2.31%, 95% CI 0.42 to 4.20, p=0.02, I2=0%) but there were not significant differences between groups in severe hypoxemia and intubation related - complications. Concerning other techniques, noninvasive ventilation (NIV) was compared to bag-valve mask in only one RCT and it reduced the degree of desaturation. CONCLUSIONS: ApOx was significantly associated with higher minimum SpO2 registered during the intubation procedure. Further studies are needed to increase the number of included patients and demonstrate the benefit of ApOx and of other respiratory support methods (e.g. NIV, HFNC).
Authors: Vincenzo Russotto; Sheila Nainan Myatra; John G Laffey; Elena Tassistro; Laura Antolini; Philippe Bauer; Jean Baptiste Lascarrou; Konstanty Szuldrzynski; Luigi Camporota; Paolo Pelosi; Massimiliano Sorbello; Andy Higgs; Robert Greif; Christian Putensen; Christina Agvald-Öhman; Athanasios Chalkias; Kristaps Bokums; David Brewster; Emanuela Rossi; Roberto Fumagalli; Antonio Pesenti; Giuseppe Foti; Giacomo Bellani Journal: JAMA Date: 2021-03-23 Impact factor: 56.272