title: Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill.
abstract: BACKGROUND
  Hypoxemia is common during endotracheal intubation of critically ill patients and may predispose to cardiac arrest and death. Administration of supplemental oxygen during laryngoscopy (apneic oxygenation) may prevent hypoxemia.
  
  
  OBJECTIVE
  To determine if apneic oxygenation increases the lowest arterial oxygen saturation experienced by patients undergoing endotracheal intubation in the intensive care unit.
  
  
  METHODS
  This was a randomized, open-label, pragmatic trial in which 150 adults undergoing endotracheal intubation in a medical intensive care unit were randomized to receive 15 L/min of 100% oxygen via high-flow nasal cannula during laryngoscopy (apneic oxygenation) or no supplemental oxygen during laryngoscopy (usual care). The primary outcome was lowest arterial oxygen saturation between induction and 2 minutes after completion of endotracheal intubation.
  
  
  RESULTS
  Median lowest arterial oxygen saturation was 92% with apneic oxygenation versus 90% with usual care (95% confidence interval for the difference, -1.6 to 7.4%; P = 0.16). There was no difference between apneic oxygenation and usual care in incidence of oxygen saturation less than 90% (44.7 vs. 47.2%; P = 0.87), oxygen saturation less than 80% (15.8 vs. 25.0%; P = 0.22), or decrease in oxygen saturation greater than 3% (53.9 vs. 55.6%; P = 0.87). Duration of mechanical ventilation, intensive care unit length of stay, and in-hospital mortality were similar between study groups.
  
  
  CONCLUSIONS
  Apneic oxygenation does not seem to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared with usual care. These findings do not support routine use of apneic oxygenation during endotracheal intubation of critically ill adults. Clinical trial registered with www.clinicaltrials.gov (NCT 02051816).
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Semler
authors.affiliation: 2 Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, Louisiana.
authors.forename: David R
authors.initials: DR
authors.lastname: Janz
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lentz
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Matthews
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Brett C
authors.initials: BC
authors.lastname: Norman
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Tufik R
authors.initials: TR
authors.lastname: Assad
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Raj D
authors.initials: RD
authors.lastname: Keriwala
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Ferrell
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Noto
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: McKown
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Emily G
authors.initials: EG
authors.lastname: Kocurek
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Warren
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Huerta
authors.affiliation: 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
mesh_terms: D000368:Aged; D001158:Arteries; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage* / Q000097:blood
chemical_list: D010100:Oxygen
keywords: airway management; intratracheal intubation; pulmonary ventilation