Erin M Vaughan1, Kevin P Seitz2, David R Janz3,4, Derek W Russell5, James Dargin6, Derek J Vonderhaar4,7, Aaron M Joffe8, Jason R West9, Wesley H Self2,10, Todd W Rice2, Matthew W Semler2, Jonathan D Casey2. 1. 12230Georgetown University School of Medicine, Washington, DC, USA. 2. 12328Vanderbilt University Medical Center, Nashville, TN, USA. 3. 473408University Medical Center New Orleans, New Orleans, LA, USA. 4. 12258Louisiana State University School of Medicine New Orleans, New Orleans, LA, USA. 5. University of Alabama Birmingham, Birmingham, AB, USA. 6. 2094Lahey Hospital and Medical Center, Burlington, MA, USA. 7. 12309Ochsner Health System New Orleans, New Orleans, LA, USA. 8. 228464University of Washington School of Medicine, Seattle, WA, USA. 9. 2011Lincoln Medical Center, Bronx, NY, USA. 10. 460460Vanderbilt Institute for Clinical and Translational Research, 5718Vanderbilt University Medical Center, Nashville, TN, USA.
Abstract
Background: Hypoxemia is common during tracheal intubation in intensive care units. To prevent hypoxemia during intubation, 2 methods of delivering oxygen between induction and laryngoscopy have been proposed: bag-mask ventilation and supplemental oxygen delivered by nasal cannula without ventilation (apneic oxygenation). Whether one of these approaches is more effective for preventing hypoxemia during intubation of critically ill patients is unknown. Methods: We performed a secondary analysis of data from 138 patients enrolled in 2, consecutive randomized trials of airway management in an academic intensive care unit. A total of 61 patients were randomized to receive bag-mask ventilation in a trial comparing bag-mask ventilation to none, and 77 patients were randomized to receive 100% oxygen at 15 L/min by nasal cannula in a trial comparing apneic oxygenation to none. Using multivariable linear regression accounting for age, body mass index, severity of illness, and oxygen saturation at induction, we compared patients assigned to bag-mask ventilation with those assigned to apneic oxygenation regarding lowest oxygen saturations from induction to 2 min after intubation. Results: Patients assigned to bag-mask ventilation and apneic oxygenation were similar at baseline. The median lowest oxygen saturation was 96% (interquartile range [IQR] 89%-100%) in the bag-mask ventilation group and 92% (IQR 84%-99%) in the apneic oxygenation group. After adjustment for prespecified confounders, bag-mask ventilation was associated with a higher lowest oxygen saturation compared to apneic oxygenation (mean difference, 4.2%; 95% confidence interval, 0.7%-7.8%; P = .02). The incidence of severe hypoxemia (oxygen saturation<80%) was 6.6% in the bag-mask ventilation group and 15.6% in the apneic oxygenation group (adjusted odds ratio, 0.33; P = .09). Conclusions: This secondary analysis of patients assigned to bag-mask ventilation and apneic oxygenation during 2 clinical trials suggests that bag-mask ventilation is associated with higher oxygen saturation during intubation compared to apneic oxygenation.
Background: Hypoxemia is common during tracheal intubation in intensive care units. To prevent hypoxemia during intubation, 2 methods of delivering oxygen between induction and laryngoscopy have been proposed: bag-mask ventilation and supplemental oxygen delivered by nasal cannula without ventilation (apneic oxygenation). Whether one of these approaches is more effective for preventing hypoxemia during intubation of critically ill patients is unknown. Methods: We performed a secondary analysis of data from 138 patients enrolled in 2, consecutive randomized trials of airway management in an academic intensive care unit. A total of 61 patients were randomized to receive bag-mask ventilation in a trial comparing bag-mask ventilation to none, and 77 patients were randomized to receive 100% oxygen at 15 L/min by nasal cannula in a trial comparing apneic oxygenation to none. Using multivariable linear regression accounting for age, body mass index, severity of illness, and oxygen saturation at induction, we compared patients assigned to bag-mask ventilation with those assigned to apneic oxygenation regarding lowest oxygen saturations from induction to 2 min after intubation. Results: Patients assigned to bag-mask ventilation and apneic oxygenation were similar at baseline. The median lowest oxygen saturation was 96% (interquartile range [IQR] 89%-100%) in the bag-mask ventilation group and 92% (IQR 84%-99%) in the apneic oxygenation group. After adjustment for prespecified confounders, bag-mask ventilation was associated with a higher lowest oxygen saturation compared to apneic oxygenation (mean difference, 4.2%; 95% confidence interval, 0.7%-7.8%; P = .02). The incidence of severe hypoxemia (oxygen saturation<80%) was 6.6% in the bag-mask ventilation group and 15.6% in the apneic oxygenation group (adjusted odds ratio, 0.33; P = .09). Conclusions: This secondary analysis of patients assigned to bag-mask ventilation and apneic oxygenation during 2 clinical trials suggests that bag-mask ventilation is associated with higher oxygen saturation during intubation compared to apneic oxygenation.
Entities:
Keywords:
critical care; endotracheal intubation; intensive care unit; respiratory failure
Authors: A S Baraka; S K Taha; S M Siddik-Sayyid; G E Kanazi; M F El-Khatib; C M Dagher; J-M A Chehade; F W Abdallah; R E Hajj Journal: Anaesthesia Date: 2007-08 Impact factor: 6.955
Authors: David R Janz; Matthew W Semler; Aaron M Joffe; Jonathan D Casey; Robert J Lentz; Bennett P deBoisblanc; Yasin A Khan; Jairo I Santanilla; Itay Bentov; Todd W Rice Journal: Chest Date: 2017-09-14 Impact factor: 9.410
Authors: Nicholas Caputo; Ben Azan; Rui Domingues; Lee Donner; Mark Fenig; Douglas Fields; Robert Fraser; Karlene Hosford; Richard Iuorio; Marc Kanter; Moira McCarty; Thomas Parry; Andaleeb Raja; Mary Ryan; Blaine Williams; Hemlata Sharma; Daniel Singer; Chris Shields; Sandra Scott; Jason R West Journal: Acad Emerg Med Date: 2017-09-23 Impact factor: 3.451
Authors: W A Knaus; D P Wagner; E A Draper; J E Zimmerman; M Bergner; P G Bastos; C A Sirio; D J Murphy; T Lotring; A Damiano Journal: Chest Date: 1991-12 Impact factor: 9.410