Application of noninvasive positive pressure ventilation in preoxygenation of critically ill patients in intensive care unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

NONG Lingbo , YU Yuheng , ZHANG Rong , LIU Dongdong , CHEN Sibei , XU Yonghao , SANG Ling , LIU Xuesong , YANG Chun , ZHOU Jing , HE Weiqun , LI Yimin , LIU Xiaoqing ,  LIANG Weibo

Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P. R. China;

Corresponding?author：

LIANG Weibo, Email: liangwei_9451@qq.com

Keywords：

Noninvasive ventilation; Preoxygenation; Intubation

DOI：

10.7507/1671-6205.202002104

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Objective To investigate whether noninvasive positive pressure ventilation (NIV) will improve preoxygenation in critically ill patients in intensive care unit (ICU) before intubation, when compared with bag-valve-mask (BVM).Methods This was a single-centered, prospective and randomized study. The patients in the study were those who required tracheal intubation in the ICU of the First Affiliated Hospital of Guangzhou Medical University and Guangzhou Institute of Respiratory Health from June 2015 to June 2017. These critically ill patients were provided with BVM or NIV assisted preoxygenation randomly. The data of the NIV group and the control group were compared and the application values of NIV in preoxygenation of critically ill patients were evaluated.Results A total of 106 patients participated in this study, including 75 males and 31 females and with an average age of (65.0±12.6) years. The patients were classified either into the control group (BVM assisted preoxygenation, n=53), or the NIV group (NIV assisted pre-oxygenation, n=53). The causes of intubation in the control group and the NIV group were as follows: pneumonia [40 patients (75.5%) vs. 39 patients (73.6%)], chronic obstructive pulmonary disease [12 patients (22.6%) vs. 11 patients (20.8%)], and other disease [1 patient (1.9%) vs. 3 patients (5.7%)], which showed no significant difference between the two groups. The scores of the Acute Physiology and Chronic Health Evaluation System Ⅱ of the control group and the NIV group were 20 (17, 26) vs. 20 (16, 26), P=0.86, which also showed no significant difference. The oxygen saturation of the pulse (SpO₂) before preoxygenation were similar in both the control group and the NIV group 92% (85%, 98%) vs. 91% (85%, 98%), P=0.87. After preoxygenation, SpO₂ was significantly higher in the NIV group than in the control group 99% (96%, 100%) vs. 96% (90%, 99%), P=0.001. For the subgroup of patients with SpO₂ less than 90% before preoxygenation, the respective SpO₂ in the control group and the NIV group were 83% (73%, 85%) vs. 81% (75%, 86%), P=0.75; after preoxygenation, SpO₂ in the NIV group was significantly higher than in the control group 99% (96%, 100%) vs. 94%(90%, 99%), P=0.000. For the subgroup of patients with SpO₂ of 90% or more before preoxygenation, the respective SpO₂ in the control group and the NIV group were similar 95.5% (92%, 99%) vs. 96% (94%, 99%), P=0.52; and continued to be similar after preoxygenation 98% (95%, 100%) vs. 99% (96%, 100%), P=0.1. The duration of mechanical ventilation of the control group and the NIV group was 17 (10, 23)d vs. 19 (11, 26)d (P=0.86). The 28 days survival rate of the control group and the NIV group was 73.6% vs. 71.7% (P=0.34). The mortality rate in the control group and NIV group were 31.3% and 31.7% (P=0.66).Conclusions When compared with the use of BVM, NIV assisted preoxygenation is effective and safe for critically ill patients. Critically ill patients with severe hypoxemia will benefit more from NIV assisted preoxygenation.

Citation： NONG Lingbo, YU Yuheng, ZHANG Rong, LIU Dongdong, CHEN Sibei, XU Yonghao, SANG Ling, LIU Xuesong, YANG Chun, ZHOU Jing, HE Weiqun, LI Yimin, LIU Xiaoqing, LIANG Weibo. Application of noninvasive positive pressure ventilation in preoxygenation of critically ill patients in intensive care unit. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(1): 17-21. doi: 10.7507/1671-6205.202002104 Copy

1.	Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med, 2012, 59(3): 165-175.
2.	Jaber S, Amraoui J, Lefrant JY, et al. 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(9): 2355-2361.
3.	Griesdale DE, Bosma TL, Kurth T, et al. Complications of endotracheal intubation in the critically ill. Intensive Care Med, 2008, 34(10): 1835-1842.
4.	Simon M, Wachs C, Braune S, et al. High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care, 2016, 61(9): 1160-1167.
5.	Groombridge C, Chin CW, Hanrahan B, et al. Assessment of common preoxygenation strategies outside of the operating room environment. Acad Emerg Med, 2016, 23(3): 342-346.
6.	Baraka AS, Taha SK, Aouad MT, et al. Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology, 1999, 91(3): 612-616.
7.	Benumof JL. Preoxygenation: best method for both efficacy and efficiency. Anesthesiology, 1999, 91(3): 603-605.
8.	Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med, 2005, 33(11): 2672-2675.
9.	Reynolds SF, Heffner J. Airway management of the critically ill patient: rapid-sequence intubation. Chest, 2005, 127(4): 1397-1412.
10.	Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology, 1995, 82(2): 367-376.
11.	Farmery AD, Roe PG. A model to describe the rate of oxyhaemoglobin desaturation during apnoea. Br J Anaesth, 1996, 76(2): 284-291.
12.	Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med, 2015, 43(3): 574-583.
13.	Vourc'h M, Asfar P, Volteau C, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med, 2015, 41(9): 1538-1548.
14.	Jaber S, Monnin M, Girard M, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med, 2016, 42(12): 1877-1887.
15.	Gregoretti C, Pisani L, Cortegiani A, et al. Noninvasive ventilation in critically ill patients. Crit Care Clin, 2015, 31(3): 435-457.
16.	Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J, 2017, 50(2): 1602426.
17.	Ouellette DR, Patel S, Girard TD, et al. Liberation from mechanical ventilation in critically ill adults: an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest, 2017, 151(1): 166-180.
18.	農凌波, 劉冬冬, 余裕恒, 等. 無創正壓通氣在重癥加強治療病房非計劃拔管患者中的應用. 中國呼吸與危重監護雜志, 2019, 18(6): 527-531.
19.	Baillard C, Fosse JP, Sebbane M, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med, 2006, 174(2): 171-177.
20.	Ho-Tai LM, Devitt JH, Noel AG, et al. Gas leak and gastric insufflation during controlled ventilation: face mask versus laryngeal mask airway. Can J Anaesth, 1998, 45(3): 206-211.
21.	Lawes EG, Campbell I, Mercer D. Inflation pressure, gastric insufflation and rapid sequence induction. Br J Anaesth, 1987, 59(3): 315-318.

1. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med, 2012, 59(3): 165-175.
2. Jaber S, Amraoui J, Lefrant JY, et al. 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(9): 2355-2361.
3. Griesdale DE, Bosma TL, Kurth T, et al. Complications of endotracheal intubation in the critically ill. Intensive Care Med, 2008, 34(10): 1835-1842.
4. Simon M, Wachs C, Braune S, et al. High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care, 2016, 61(9): 1160-1167.
5. Groombridge C, Chin CW, Hanrahan B, et al. Assessment of common preoxygenation strategies outside of the operating room environment. Acad Emerg Med, 2016, 23(3): 342-346.
6. Baraka AS, Taha SK, Aouad MT, et al. Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology, 1999, 91(3): 612-616.
7. Benumof JL. Preoxygenation: best method for both efficacy and efficiency. Anesthesiology, 1999, 91(3): 603-605.
8. Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med, 2005, 33(11): 2672-2675.
9. Reynolds SF, Heffner J. Airway management of the critically ill patient: rapid-sequence intubation. Chest, 2005, 127(4): 1397-1412.
10. Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology, 1995, 82(2): 367-376.
11. Farmery AD, Roe PG. A model to describe the rate of oxyhaemoglobin desaturation during apnoea. Br J Anaesth, 1996, 76(2): 284-291.
12. Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med, 2015, 43(3): 574-583.
13. Vourc'h M, Asfar P, Volteau C, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med, 2015, 41(9): 1538-1548.
14. Jaber S, Monnin M, Girard M, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med, 2016, 42(12): 1877-1887.
15. Gregoretti C, Pisani L, Cortegiani A, et al. Noninvasive ventilation in critically ill patients. Crit Care Clin, 2015, 31(3): 435-457.
16. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J, 2017, 50(2): 1602426.
17. Ouellette DR, Patel S, Girard TD, et al. Liberation from mechanical ventilation in critically ill adults: an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest, 2017, 151(1): 166-180.
18. 農凌波, 劉冬冬, 余裕恒, 等. 無創正壓通氣在重癥加強治療病房非計劃拔管患者中的應用. 中國呼吸與危重監護雜志, 2019, 18(6): 527-531.
19. Baillard C, Fosse JP, Sebbane M, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med, 2006, 174(2): 171-177.
20. Ho-Tai LM, Devitt JH, Noel AG, et al. Gas leak and gastric insufflation during controlled ventilation: face mask versus laryngeal mask airway. Can J Anaesth, 1998, 45(3): 206-211.
21. Lawes EG, Campbell I, Mercer D. Inflation pressure, gastric insufflation and rapid sequence induction. Br J Anaesth, 1987, 59(3): 315-318.

Chinese Journal of Respiratory and Critical Care Medicine

Application of noninvasive positive pressure ventilation in preoxygenation of critically ill patients in intensive care unit

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