title: Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia.
abstract: OBJECTIVE
  Tracheal intubation of ICU patients is frequently associated with severe hypoxemia. Although noninvasive ventilation reduces desaturation during intubation of severely hypoxemic patients, it does not allow for per-procedure oxygenation and has not been evaluated in mild-to-moderate hypoxemic patients for whom high-flow nasal cannula oxygen may be an alternative. We sought to compare pre- and per-procedure oxygenation with either a nonrebreathing bag reservoir facemask or a high-flow nasal cannula oxygen during tracheal intubation of ICU patients.
  
  
  METHODS
  Prospective quasi-experimental before-after study (ClinicalTrials.gov: NCT01699880).
  
  
  METHODS
  University hospital medico-surgical ICU.
  
  
  METHODS
  All adult patients requiring tracheal intubation in the ICU were eligible.
  
  
  METHODS
  In the control (before) period, preoxygenation was performed with a nonrebreathing bag reservoir facemask and in the change of practice (after) period, with high-flow nasal cannula oxygen.
  
  
  RESULTS
  Primary outcome was median lowest SpO2 during intubation, and secondary outcomes were SpO2 after preoxygenation and number of patients with saturation less than 80%. One hundred one patients were included. Median lowest SpO2 during intubation were 94% (83-98.5) with the nonrebreathing bag reservoir facemask versus 100% (95-100) with high-flow nasal cannula oxygen (p < 0.0001). SpO2 values at the end of preoxygenation were higher with high-flow nasal cannula oxygen than with nonrebreathing bag reservoir facemask and were correlated with the lowest SpO2 reached during the intubation procedure (r = 0.38, p < 0.0001). Patients in the nonrebreathing bag reservoir facemask group experienced more episodes of severe hypoxemia (2% vs 14%, p = 0.03). In the multivariate analysis, preoxygenation with high-flow nasal cannula oxygen was an independent protective factor of the occurrence of severe hypoxemia (odds ratio, 0.146; 95% CI, 0.01-0.90; p = 0.037).
  
  
  CONCLUSIONS
  High-flow nasal cannula oxygen significantly improved preoxygenation and reduced prevalence of severe hypoxemia compared with nonrebreathing bag reservoir facemask. Its use could improve patient safety during intubation.
authors.affiliation: 1Medico-Surgical Intensive Care Unit, Hôpital Louis Mourier, AP-HP, Colombes, France. 2Department of Epidemiology and Clinical Research, Hôpital Louis Mourier, AP-HP, Colombes, France. 3Institut National de la Santé et de la Recherche Médicale (INSERM), IAME, UMR 1137, F-75018, Paris, France. 4Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Miguel-Montanes
authors.forename: David
authors.initials: D
authors.lastname: Hajage
authors.forename: Jonathan
authors.initials: J
authors.lastname: Messika
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bertrand
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.forename: Cédric
authors.initials: C
authors.lastname: Rafat
authors.forename: Vincent
authors.initials: V
authors.lastname: Labbé
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dufour
authors.forename: Sylvain
authors.initials: S
authors.lastname: Jean-Baptiste
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bedet
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006785:Hospitals, University; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*
chemical_list: D010100:Oxygen