Table 1 Characteristics of the five studies on pre-oxygenation techniques
1st Author | Journal, year | Setting | Patients’ characteristics | Pre-oxygenation intervention | Pre-oxygenation comparator | Primary outcome | Comments |
|---|---|---|---|---|---|---|---|
Baillard C et al. [11] | Am J Resp Crit Care Med, 2006 | ICU | Severely hypoxemic patients | Pre-oxygenation with NIV | Pre-oxygenation nonrebreather bag-valve mask driven by 15 L/min oxygen. Patients were allowed to breath spontaneously with occasional assistance | Mean drop in SpO2 during ETI | SpO2 values were significantly better in the NIV group after pre-oxygenation, during intubation, and 5 min after intubation Episodes of SpO2 < 80% were significantly less common in the NIV group (p < 0.01). |
Vourc’h M et al. [12] | Intensive Care Med, 2015 | ICU | Severely hypoxemic patients | Pre-oxygenation and apneic oxygenation with HFNC (maintained during laryngoscopy) | HFO by facemask followed by no supplemental O2 during laryngoscopy | Lowest SpO2 throughout intubation procedure | No significant difference in any peri-procedural oxygenation parameter. Duration of mechanical ventilation was shorter in the HFNC group. |
Jaber S et al. [13] | Intensive Care Med, 2016 | ICU | Severely hypoxemic patients | Pre-oxygenation with NIV plus HFNC, then apneic oxygenation with HFNC (maintained during laryngoscopy) | Pre-oxygenation with NIV plus sham HFNC, then apneic oxygenation with sham HFNC (maintained during laryngoscopy) | Lowest SpO2 during ETI | Lowest SpO2 during intubation higher in the intervention group. In per-protocol analysis, fewer severe desaturation episodes in the intervention group. |
Simon M et al. [14] | Resp Care, 2016 | ICU | Severely hypoxemic patients | Pre-oxygenation with HFNC, then apneic oxygenation with HFNC (maintained during laryngoscopy) | Bag -valve mask and no supplemental O2 during laryngoscopy | Mean lowest SpO2 during ETI | No difference at any time points in SpO2 or pCO2, and in procedural-related complications. |
Semler MW et al. [15] | Am J Resp Crit Care Med, 2016 | ICU | Critically ill patients | Not standardized pre-oxygenation followed by apneic oxygenation with HFNC during laryngoscopy | Not standardized pre-oxygenation and no supplemental O2 during laryngoscopy | Lowest SpO2 between induction and 2 min after ETI | No significant difference in any peri-procedural oxygenation parameter. No difference in short-term and hospital mortality. |
Caputo N et al. [16] | Acad Emerg Med, 2017 | ED | Critically ill patients | Standard 3-min pre-oxygenation followed by apneic oxygenation with HFNC during laryngoscopy | Standard 3-min pre-oxygenation and no supplemental O2 during laryngoscopy | Average lowest SpO2 during apnea and in the following 2 minutes | No difference in lowest average SpO2, no difference in SpO2 at any time-point, no difference in the rates of moderate or severe desaturation episodes. |