Published ahead of print on April 20, 2006, doi:10.1164/rccm.200509-1507OC
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 171-177, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200509-1507OC
Noninvasive Ventilation Improves Preoxygenation before Intubation of Hypoxic Patients
Christophe Baillard,
Jean-Philippe Fosse,
Mustapha Sebbane,
Gérald Chanques,
Francçois Vincent,
Patricia Courouble,
Yves Cohen,
Jean-Jacques Eledjam,
Frédéric Adnet and
Samir Jaber
Department of Anesthesiology and Intensive Care, and SAMU 93, Avicenne Hospital, Paris 13 University–AP-HP, Bobigny; Intensive Care Unit, Department of Anesthesiology, DAR B University Hospital of Montpellier, and Saint Eloi Hospital, Montpellier University, Montpellier, France
Correspondence and requests for reprints should be addressed to Dr. Samir Jaber, M.D., Ph.D., Intensive Care Unit, Department of Anesthesiology, DAR B CHU de Montpellier, Hôpital Saint Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. E-mail: s-jaber{at}chu-montpellier.fr
Rationale: Critically ill patients are predisposed to oxyhemoglobin desaturation during intubation.
Objectives: To find out whether noninvasive ventilation (NIV), as a preoxygenation method, is more effective at reducing arterial oxyhemoglobin desaturation than usual preoxygenation during orotracheal intubation in hypoxemic, critically ill patients.
Methods: Prospective randomized study performed in two surgical/medical intensive care units (ICUs). Preoxygenation was performed, before a rapid sequence intubation, for a 3-min 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) before preoxygenation. At the end of preoxygenation, SpO2 was higher in the NIV group as compared with the control group (98 ± 2 vs. 93 ± 6%, p < 0.001). During the 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 two (7%) in the NIV group had an SpO2 below 80% (p < 0.01). Five minutes after intubation, SpO2 values were still better in the NIV group as compared with the control group (98 ± 2 vs. 94 ± 6%, p < 0.01). Regurgitations (n = 3; 6%) and new infiltrates on post-procedure chest X 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 oxyhemoglobin desaturation than the usual method.
Key Words: continuous positive airway pressure • intubation • preoxygenation
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