Thursday February 21, 2008
Noninvasive Ventilation before Intubation of Hypoxic Patients ?

If enough denitrogenation is not provided critically ill patients are predisposed to quick desaturation during intubation. We found this new approach before intubation in hypoxic patients.

Prospective randomized study was performed, with 2 groups, the control (n = 26) and NIV (n = 27). 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.

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.

Results:

• At the end of preoxygenation, SpO2 was higher in the NIV group as compared with the control group (98 ± 2 vs. 93 ± 6%,)
• During the intubation procedure, the lower SpO2 values were observed in the control group (81 ± 15 vs. 93 ± 8%)
• Twelve (46%) patients in the control group and two (7%) in the NIV group had an SpO2 below 80%
• Five minutes after intubation, SpO2 values were still better in the NIV group as compared with the control group (98 ± 2 vs. 94 ± 6%)
• 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.

Reference: click to get abstract /article

Noninvasive Ventilation Improves Preoxygenation before Intubation of Hypoxic Patients, American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 171-177, (2006)