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American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 1274a, (2006)
© 2006 American Thoracic Society

Correspondence

Noninvasive Ventilation versus Nonrebreather Bag–Valve Mask to Achieve Preoxygenation before Intubation of Hypoxic Patients

From the Authors:

We thank Drs. Lopera and Quintana for their comments on our recent article (1), which help us to clarify the description of our method of oxygen delivery. Indeed, they correctly point out that preoxygenation effectiveness depends on the FIO2 delivery methodology, which in turn depends on whether an oxygen reservoir is added or not to the balloon (2). In our study, we used a balloon with an oxygen reservoir bag, which allowed us to deliver high FIO2, a system widely used in the intensive care units (3). This information is helpful in interpreting the study's conclusions. The significant improvement in oxygenation observed after 3 min of preoxygenation using noninvasive ventilation (NIV) is probably due to the recruitment of collapsed alveoli rather than a higher delivered oxygen concentration (1, 4). It is also important to notice that the beneficial effect on PaO2 was still observed 30 min after endotracheal intubation in patients receiving NIV during preoxygenation. One explanation could be again the effect of NIV in recruiting alveoli and increasing lung volume prior to intubation.

Christophe Baillard

Avicenne Hospital Paris 13 University—AP-HP, EA 3409 Bobigny, France

Samir Jaber

University Hospital of Montpellie and Saint Eloi Hospital, Montpellier University, Montpellier, France

FOOTNOTES

Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

  1. Baillard C, Fosse J-P, Sebbane M, Chanques G, Vincent F, Courouble P, Cohen Y, Eledjam J-J, Adnet F, Jaber S. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med 2006;174:171–177.[Abstract/Free Full Text]
  2. Quintana S, Martinez Perez J, Alvarez M, Vila JS, Jara F, Nava JM. Maximum FIO2 in minimum time depending on the kind of resuscitation bag and oxygen flow. Intensive Care Med 2004;30:155–158.[CrossRef][Medline]
  3. Jaber S, Amraoui J, Lefrant JY, Arich C, Cohendy R, Landreau L, Calvet Y, Capdevila X, Mahamat A, Eledjam JJ. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 2006;34:2355–2361.[CrossRef][Medline]
  4. Rusca M, Proietti S, Schnyder P, Frascarolo P, Hedenstierna G, Spahn DR, Magnusson L. Prevention of atelectasis formation during induction of general anesthesia. Anesth Analg 2003;97:1835–1839.[Abstract/Free Full Text]




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Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2006 American Thoracic Society