Comparative Study on Preoxygenation for Emergency Tracheal Intubation in Severe Patients_West China Medical Journal

Authors：

 XUZhi-hua ,  JIANGHan , WANGYan , JIAChao

Intensive Care Unit, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

JIANGHan, Email: jianghan126@gmail.com

Keywords：

Intubation; Preoxygenation; Intensive care

DOI：

10.7507/1002-0179.20150583

Video：

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Objective To observe the effect of different preoxygenation methods for emergency intubation in severe patients in intensive care unit (ICU). Methods Prospective randomized study was performed in the intensive care unit between June 2013 and January 2014. Forty patients were randomly divided into 4 groups:group A (control group, n=10), group B (bag-valve-mask preoxygenation group, n=10), group C (noninvasive ventilator-mask preoxygenation group, n=10), and group D (invasive ventilator-mask preoxygenation group, n=10). Standardized rapid sequence intubation was performed without preoxygenation in group A; preoxygenation was performed by using a bag-valve-mask rose pulse oxygen saturation (SpO₂) to 90% before a rapid sequence intubation in group B; preoxygenation was performed by using noninvasive ventilator through a face mask rose SpO₂ to 90% before a rapid sequence intubation in group C; and preoxygenation was performed by using invasive ventilator through a face mask rose SpO₂ to 90% before a rapid sequence intubation in group D. We recorded the time when SpO₂ was more than or equal to 90% in group B, C, and D, and arterial blood gases and complications were observed. Results There was no significant difference in the basic indexes before preoxygenation among the four groups (P>0.05). The time of the patients in group D and C was significantly lower than that of group B. The arterial oxygen saturation (SaO₂) and arterial oxygen partial pressure (PaO₂) in the group C and D were higher than those in group B after preoxygenation (P<0.05). After intubation, SpO₂ in group B, C and D was significantly higher than that in group A (P<0.05). At the same time, SpO₂ in group C and D was higher than that in group B (P<0.05); PaO₂ and SaO₂ in group C and D were higher than in those in group A and B (P<0.05); SaO₂ in group D was higher than that in group B (P<0.05). The incidence of abdominal distension in group D was significantly lower than that of group B and C (P<0.05). Conclusion For emergency tracheal intubation in critically ill patients in the ICU, preoxygenation is more effective than the rapid sequence intubation without preoxygenation in improving oxygenation indicators. Invasive ventilator-mask preoxygenation efficacy and safety are superior to other methods.

Citation： XUZhi-hua, JIANGHan, WANGYan, JIAChao. Comparative Study on Preoxygenation for Emergency Tracheal Intubation in Severe Patients. West China Medical Journal, 2015, 30(11): 2054-2058. doi: 10.7507/1002-0179.20150583 Copy

1.	Schwartz D, Matthay M. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations[J]. Anesthesiology, 1995, 82(2):367-376.
2.	Tanoubi I, Drolet P, Donati F. Optimizing preoxygenation in adults[J]. Can J Anaesth, 2009, 56(6):449-466.
3.	孙东光, 李海波, 王怀泉, 等. 重症患者急救插管预氧合的临床研究[J]. 现代生物医学进展, 2014, 14(30):5952.
4.	Divatia JV, Khan PU, Myatra SN. Tracheal intubation in the ICU:life saving or life threatening[J]. Indian J Anaesth, 2011, 55(5):470-475.
5.	Ghoshal S, Bhattacharyya T, Sood A, et al. Palliative radiation in primary squamous cell carcinoma of thyroid:a rare case report[J]. Indian J Palliat Care, 2013, 19(3):192-194.
6.	Baillard C, Fosse JP, Sebbane MA, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients[J]. Am J Respir Crit Care Med, 2006, 174(2):171-177.
7.	Stafford R, Benger J, Nolan J. Preoxygenation remains essential before emergency tracheal intubation[J]. Crit Care Med, 2006, 34(6):1859-1860.
8.	张鲁军. 气管插管前应用面罩行机械通气的效果观察探讨[J]. 齐鲁护理杂志, 2006, 12(24):2435-2436.
9.	Brown JP, Werrett G. Bag-mask ventilation in rapid sequence induction[J]. Anaesthesia, 2009, 64(7):784-785.
10.	Dorges V, Wenzel V, Knacke P, et al. Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated patients[J]. Crit Care Med, 2003, 31(3):800-804.
11.	Weitzenblum E, Chaouat A, Kessler R, et al. The overlap syndrome:association of COPD and obstructive sleep apnoea[J]. Rev Mal Respir, 2010, 27(4):329-340.
12.	Lopera JL. Quintana S. Noninvasive ventilation versus nonrebreatherbag-valve mask to achieve preoxygenation before intubation of hypoxic patients[J]. Am J Respir Crit Care Med, 2006, 174(11):1274.
13.	Mort TC, Waberski BH, Clive J. Extending the preoxygenation period from 4 to 8 mins in critically ill patients undergoing emergency intubation[J]. Crit Care Med, 2009, 37(1):68-71.
14.	Wu HX, Zhang BJ, Wang J, et al. Conventional ultrasonography and real time ultrasound elastography in the differential diagnosis of degenerating cystic thyroid nodules mimicking malignancy and papillary thyroid carcinomas[J]. Asian Pac J Cancer Prev, 2013, 14(2):935-940.
15.	von Goedecke A, Wenzel V, Hörmann C, et al. Effects of face mask ventilation in apneic patients with a resuscitation ventilator in comparison with a bag-valve-mask[J]. J Emerg Med, 2006, 30(1):63-67.
16.	Auf derheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation[J]. Circulation, 2004, 109(16):1960-1965.

1. Schwartz D, Matthay M. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations[J]. Anesthesiology, 1995, 82(2):367-376.
2. Tanoubi I, Drolet P, Donati F. Optimizing preoxygenation in adults[J]. Can J Anaesth, 2009, 56(6):449-466.
3. 孙东光, 李海波, 王怀泉, 等. 重症患者急救插管预氧合的临床研究[J]. 现代生物医学进展, 2014, 14(30):5952.
4. Divatia JV, Khan PU, Myatra SN. Tracheal intubation in the ICU:life saving or life threatening[J]. Indian J Anaesth, 2011, 55(5):470-475.
5. Ghoshal S, Bhattacharyya T, Sood A, et al. Palliative radiation in primary squamous cell carcinoma of thyroid:a rare case report[J]. Indian J Palliat Care, 2013, 19(3):192-194.
6. Baillard C, Fosse JP, Sebbane MA, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients[J]. Am J Respir Crit Care Med, 2006, 174(2):171-177.
7. Stafford R, Benger J, Nolan J. Preoxygenation remains essential before emergency tracheal intubation[J]. Crit Care Med, 2006, 34(6):1859-1860.
8. 张鲁军. 气管插管前应用面罩行机械通气的效果观察探讨[J]. 齐鲁护理杂志, 2006, 12(24):2435-2436.
9. Brown JP, Werrett G. Bag-mask ventilation in rapid sequence induction[J]. Anaesthesia, 2009, 64(7):784-785.
10. Dorges V, Wenzel V, Knacke P, et al. Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated patients[J]. Crit Care Med, 2003, 31(3):800-804.
11. Weitzenblum E, Chaouat A, Kessler R, et al. The overlap syndrome:association of COPD and obstructive sleep apnoea[J]. Rev Mal Respir, 2010, 27(4):329-340.
12. Lopera JL. Quintana S. Noninvasive ventilation versus nonrebreatherbag-valve mask to achieve preoxygenation before intubation of hypoxic patients[J]. Am J Respir Crit Care Med, 2006, 174(11):1274.
13. Mort TC, Waberski BH, Clive J. Extending the preoxygenation period from 4 to 8 mins in critically ill patients undergoing emergency intubation[J]. Crit Care Med, 2009, 37(1):68-71.
14. Wu HX, Zhang BJ, Wang J, et al. Conventional ultrasonography and real time ultrasound elastography in the differential diagnosis of degenerating cystic thyroid nodules mimicking malignancy and papillary thyroid carcinomas[J]. Asian Pac J Cancer Prev, 2013, 14(2):935-940.
15. von Goedecke A, Wenzel V, Hörmann C, et al. Effects of face mask ventilation in apneic patients with a resuscitation ventilator in comparison with a bag-valve-mask[J]. J Emerg Med, 2006, 30(1):63-67.
16. Auf derheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation[J]. Circulation, 2004, 109(16):1960-1965.

West China Medical Journal

Comparative Study on Preoxygenation for Emergency Tracheal Intubation in Severe Patients

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