Published ahead of print on April 20, 2006, doi:10.1164/rccm.200509-1507OC
Am. J. Respir. Crit. Care Med., Volume 174, Number 2, July 2006, 171-177
A more recent version of this article appeared on July 15, 2006
Submitted on September 27, 2005
Accepted on April 20, 2006
Noninvasive Ventilation Improves Preoxygenation Before Intubation of Hypoxic Patients
Christophe Baillard1, Jean-Philippe Fosse1, Mustapha Sebbane2, Gerald Chanques2, Francois Vincent1, Patricia Courouble2, Yves Cohen1, Jean-Jacques Eledjam2, Frederic Adnet1, and Samir Jaber2*
1 Department of Anesthesiology and Intensive Care and SAMU 93, Avicenne Hospital, Bobigny, France,
2 Intensive Care Unit, Department of Anesthesiology: DAR B, University Hospital of Montpellier, Saint Eloi Hospital, Montpellier, France
* To whom correspondence should be addressed. E-mail: s-jaber{at}chu-montpellier.fr.
Rationale: Critically ill patients are predisposed to oxyhaemoglobin desaturation during intubation.
Objectives: To find out whether non invasive ventilation (NIV), as a preoxygenation method, is more effective at reducing arterial oxyhaemoglobin desaturation than usual preoxygenation during oro-tracheal intubation in hypoxemic critically ill patient.
Methods: Prospective randomized study performed in two surgical-medical ICU's. Preoxygenation was performed, prior a rapid sequence intubation, for a 3-minute period using a nonrebreather bag-valve mask (control group) or pressure support ventilation delivered by an ICU ventilator through a face mask (NIV group) according to the randomization.
Measurements and Main Results: The Control (n=26) and NIV (n=27) groups were similar in terms of age, disease severity, diagnosis at admission and pulse oxymetry values (SpO2) prior preoxygenation. At the end of preoxygenation, SpO2 was higher in NIV group as compared to control group, 98±2 % vs 93±6, p<0.001. During intubation procedure, the lower SpO2 values were observed in the control group, 81±15% vs 93±8%, p<0.001. Twelve (46%) patients in the control group and 2 (7%) in the NIV group had a SpO2 below 80%, p<0.01. Five minutes after intubation, SpO2 values were still better in NIV group as compared to control group, 98±2 vs 94±6 %, p<0.01. Regurgitations, n=3 (6%), and new infiltrates on post procedure X-chest ray, n=4 (8%) were observed with no significant difference between groups.
Conclusion: For the intubation of hypoxemic patients, preoxygenation using NIV is more effective at reducing arterial oxyhaemoglobin desaturation than usual method.
Key words: Preoxygenation, Continuous Positive Airway Pressure, Intubation
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