Cargando…

Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials

BACKGROUND: Patients with acute hypoxemic respiratory failure are at risk for life-threatening complications during endotracheal intubation. Preoxygenation might help reduce the risk of hypoxemia and intubation-related complications. This network meta-analysis summarizes the efficacy and safety of p...

Descripción completa

Detalles Bibliográficos
Autores principales: Fong, Ka Man, Au, Shek Yin, Ng, George Wing Yiu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751657/
https://www.ncbi.nlm.nih.gov/pubmed/31533792
http://dx.doi.org/10.1186/s13054-019-2596-1
_version_ 1783452653934608384
author Fong, Ka Man
Au, Shek Yin
Ng, George Wing Yiu
author_facet Fong, Ka Man
Au, Shek Yin
Ng, George Wing Yiu
author_sort Fong, Ka Man
collection PubMed
description BACKGROUND: Patients with acute hypoxemic respiratory failure are at risk for life-threatening complications during endotracheal intubation. Preoxygenation might help reduce the risk of hypoxemia and intubation-related complications. This network meta-analysis summarizes the efficacy and safety of preoxygenation methods in adult patients with acute hypoxemic respiratory failure. METHODS: We searched PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials through April 2019 for randomized controlled trials (RCT) that studied the use of conventional oxygen therapy (COT), high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and HFNC and NIV as preoxygenation before intubation in patients with acute hypoxemic respiratory failure. Citations’ screening, study selection, data extraction, and risk of bias assessment were independently performed by two authors. The primary outcome was the lowest SpO(2) during the intubation procedure. RESULTS: We included 7 RCTs (959 patients). Patients preoxygenated with NIV had significantly less desaturation than patients treated with COT (mean difference, MD 5.53, 95% CI 2.71, 8.34) and HFNC (MD 3.58, 95% CI 0.59, 6.57). Both NIV (odds ratio, OR 0.43, 95% CI 0.21, 0.87) and HFNC (OR 0.49, 95% CI 0.28, 0.88) resulted in a lower risk of intubation-related complications than COT. There were no significant mortality differences among the use of NIV, HFNC, COT, and HFNC and NIV during preoxygenation. CONCLUSIONS: In adult patients with acute hypoxemic respiratory failure, NIV is a safe and probably the most effective preoxygenation method.
format Online
Article
Text
id pubmed-6751657
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-67516572019-09-23 Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials Fong, Ka Man Au, Shek Yin Ng, George Wing Yiu Crit Care Research BACKGROUND: Patients with acute hypoxemic respiratory failure are at risk for life-threatening complications during endotracheal intubation. Preoxygenation might help reduce the risk of hypoxemia and intubation-related complications. This network meta-analysis summarizes the efficacy and safety of preoxygenation methods in adult patients with acute hypoxemic respiratory failure. METHODS: We searched PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials through April 2019 for randomized controlled trials (RCT) that studied the use of conventional oxygen therapy (COT), high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and HFNC and NIV as preoxygenation before intubation in patients with acute hypoxemic respiratory failure. Citations’ screening, study selection, data extraction, and risk of bias assessment were independently performed by two authors. The primary outcome was the lowest SpO(2) during the intubation procedure. RESULTS: We included 7 RCTs (959 patients). Patients preoxygenated with NIV had significantly less desaturation than patients treated with COT (mean difference, MD 5.53, 95% CI 2.71, 8.34) and HFNC (MD 3.58, 95% CI 0.59, 6.57). Both NIV (odds ratio, OR 0.43, 95% CI 0.21, 0.87) and HFNC (OR 0.49, 95% CI 0.28, 0.88) resulted in a lower risk of intubation-related complications than COT. There were no significant mortality differences among the use of NIV, HFNC, COT, and HFNC and NIV during preoxygenation. CONCLUSIONS: In adult patients with acute hypoxemic respiratory failure, NIV is a safe and probably the most effective preoxygenation method. BioMed Central 2019-09-18 /pmc/articles/PMC6751657/ /pubmed/31533792 http://dx.doi.org/10.1186/s13054-019-2596-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Fong, Ka Man
Au, Shek Yin
Ng, George Wing Yiu
Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials
title Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials
title_full Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials
title_fullStr Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials
title_full_unstemmed Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials
title_short Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials
title_sort preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751657/
https://www.ncbi.nlm.nih.gov/pubmed/31533792
http://dx.doi.org/10.1186/s13054-019-2596-1
work_keys_str_mv AT fongkaman preoxygenationbeforeintubationinadultpatientswithacutehypoxemicrespiratoryfailureanetworkmetaanalysisofrandomizedtrials
AT aushekyin preoxygenationbeforeintubationinadultpatientswithacutehypoxemicrespiratoryfailureanetworkmetaanalysisofrandomizedtrials
AT nggeorgewingyiu preoxygenationbeforeintubationinadultpatientswithacutehypoxemicrespiratoryfailureanetworkmetaanalysisofrandomizedtrials