Noninvasive ventilation support during fiberoptic bronchoscopy-guided nasotracheal intubation effectively prevents severe hypoxemia.

Abstract

PURPOSE:

This study investigated the feasibility and efficacy of continuous noninvasive ventilation (NIV) support with 100% oxygen using a specially designed face mask, for reducing desaturation during fiberoptic bronchoscopy (FOB)-guided intubation in critically ill patients with respiratory failure.

MATERIALS AND METHODS:

This was a single-center prospective randomized study. All patients undergoing FOB-guided nasal tracheal intubation were randomized to bag-valve-mask ventilation or NIV for preoxygenation followed by intubation. The NIV group were intubated through a sealed hole in a specially designed face mask during continuous NIV support with 100% oxygen. Control patients were intubated with removal of the mask and no ventilatory support.

RESULTS:

We enrolled 106 patients, including 53 in each group. Pulse oxygen saturation (SpO2) after preoxygenation (99% (96%-100%) vs. 96% (90%-99%), p = .001) and minimum SpO2 during intubation (95% (87%-100%) vs. 83% (74%-91%), p < .01) were both significantly higher in the NIV compared with the control group. Severe hypoxemic events (SpO2 < 80%) occurred less frequently in the NIV group than in controls (7.4% vs. 37.7%, respectively; p < .01).

CONCLUSIONS:

Continuous NIV support during FOB-guided nasal intubation can prevent severe desaturation during intubation in critically ill patients with respiratory failure.

TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02462668. Registered on 25 May 2015, https://www.clinicaltrials.gov/ct2/results?term=NCT02462668.

• Authors: Lingbo Nong, Weibo Liang, Yuheng Yu, Yin Xi, Dongdong Liu, Jie Zhang, Jing Zhou, Chun Yang, Weiqun He, Xiaoqing Liu, Yimin Li, Rongchang Chen
• Journal: Journal of critical care (J Crit Care) Vol. 56 Pg. 12-17 (04 2020) ISSN: 1557-8615 [Electronic] United States
• PMID: 31785505 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019. Published by Elsevier Inc.

Chemical References

• Oxygen

Topics

• Adult
• Aged
• Bronchoscopy
• Critical Illness
• Female
• Fiber Optic Technology
• Humans
• Hypoxia (prevention & control, therapy)
• Intubation, Intratracheal (methods)
• Male
• Middle Aged
• Noninvasive Ventilation
• Oxygen
• Prospective Studies
• Respiration, Artificial
• Respiratory Insufficiency
• Treatment Outcome