Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis

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RESEARCH PRODUCT

Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis

Andrea Cortegiani Cesare Gregoretti Santi Maurizio Raineri Vincenzo Russotto Antonino Giarratano

subject

Critical Care Databases Factual medicine.medical_treatment Airway management; Apneic oxygenation; Endotracheal intubation; Noninvasive ventilation; Oxygen inhalation therapy; Preoxygenation Critical Illness Settore MED/41 - Anestesiologia Endotracheal intubation Airway management Cochrane Library Critical Care and Intensive Care Medicine medicine.disease_cause law.invention 03 medical and health sciences 0302 clinical medicine Apneic oxygenation Randomized controlled trial law Preoxygenation medicine Intubation Intratracheal Intubation Cannula Humans MED/41 - ANESTESIOLOGIA Hypoxia business.industry Oxygen inhalation therapy 030208 emergency & critical care medicine Endotracheal intubation Respiration Artificial Intubation procedure 030228 respiratory system Meta-analysis Anesthesia Critical Illne Airway management business Respiratory Insufficiency Nasal cannula Noninvasive ventilation Human

description

Abstract Purpose To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation. Methods We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. Results Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients). Three of these studies investigated high-flow nasal cannula (HFNC) for ApOx while standard nasal cannula was used in one. Globally, ApOx was associated with higher minimum SpO2 value compared to those receiving ETI without ApOx (mean difference 2.31%, 95% CI 0.42 to 4.20, p = 0.02, I2 = 0%) but there were not significant differences between groups in severe hypoxemia and intubation related – complications. Concerning other techniques, noninvasive ventilation (NIV) was compared to bag-valve mask in only one RCT and it reduced the degree of desaturation. Conclusions ApOx was significantly associated with higher minimum SpO2 registered during the intubation procedure. Further studies are needed to increase the number of included patients and demonstrate the benefit of ApOx and of other respiratory support methods (e.g. NIV, HFNC).

year	journal	country	edition	language
2017-01-01

10.1016/j.jcrc.2017.05.003 http://hdl.handle.net/10447/235173