Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients
Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients
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DOI：
10.1164/rccm.200509-1507oc
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发表时间：
2006-07-15
影响因子：
24.7
通讯作者：
Jaber, Samir
中科院分区：
文献类型：
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作者：
Baillard, Christophe;Fosse, Jean-Philippe;Jaber, Samir
理由：危重患者在插管期间易发生血红蛋白氧饱和度降低。目的：探讨无创通气（NIV）作为一种预充氧方法，在低氧血症危重患者经气管插管时是否比常规预充氧更有效地降低动脉氧合血红蛋白失饱和度。方法：在两个外科/内科重症监护病房（icu）进行前瞻性随机研究。根据随机分组，在快速顺序插管前，使用非呼吸袋-阀面罩（对照组）进行预充氧3分钟，或由ICU呼吸机通过面罩进行压力支持通气（NIV组）。测量和主要结果：对照组（n = 26）和NIV组（n = 27）在年龄、疾病严重程度、入院诊断和预充氧前脉搏血氧仪值（SPO2）方面相似。预充氧结束时，NIV组SPO2高于对照组（98 +/- 2比93 +/- 6%，p < 0.001）。在插管过程中，对照组的SPO2值较低（81 +/- 15% vs 93 +/- 8%, p < 0.001）。对照组12例（46%），NIV组2例（7%）SPO2低于80% （p < 0.01）。插管5 min后，NIV组Sp（O2）值仍优于对照组（98 +/- 2 vs 94 +/- 6%, p < 0.01）。返流（n = 3, 6%）及术后胸部X线新发浸润（n = 4, 8%）组间差异无统计学意义。结论：对于低氧血症患者插管时，采用NIV预充氧比常规方法更能有效降低动脉血红蛋白氧饱和度。
Rationale: Critically ill patients are predisposed to oxyhemoglobin desaturation during intubation.Objectives: To find out whether noninvasive ventilation (NIV), as a preoxygenation method, is more effective at reducing arterial oxyhemoglobin desaturation than usual preoxygenation during orotracheal intubation in hypoxemic, critically ill patients.Methods: Prospective randomized study performed in two surgical/medical intensive care units (ICUs). Preoxygenation was performed, before a rapid sequence intubation, for a 3-min period using a nonrebreather bag-valve mask (control group) or pressure support ventilation delivered by an ICU ventilator through a face mask (NIV group) according to the randomization.Measurements and Main Results: The control (n = 26) and NIV (n 27) groups were similar in terms of age, disease severity, diagnosis at admission, and pulse oxymetry values (SPO2) before preoxygenation. At the end of preoxygenation, SPO2 was higher in the NIV group as compared with the control group (98 +/- 2 vs. 93 +/- 6%, p < 0.001). During the intubation procedure, the lower SPO2 values were observed in the control group (81 +/- 15 vs. 93 +/- 8%, p < 0.001). Twelve (46%) patients in the control group and two (7%) in the NIV group had an SPO2 below 80% (p < 0.01). Five minutes after intubation, Sp(O2) values were still better in the NIV group as compared with the control group (98 +/- 2 vs. 94 +/- 6%, p < 0.01). Regurgitations (n = 3; 6%) and new infiltrates on post-procedure chest X ray (n = 4; 8%) were observed with no significant difference between groups.Conclusion: For the intubation of hypoxemic patients, preoxygenation using NIV is more effective at reducing arterial oxyhemoglobin desaturation than the usual method.