Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial
OBJECTIVES: In the context of acute hypoxemic respiratory failure (AHRF), ensuring effective preoxygenation and apneic oxygenation emerges as the pivotal approach ensuring for averting hypoxemic adverse events during endotracheal intubation. To investigate this, we conducted an open-label randomized...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-01-01
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| Series: | Turkish Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.turkjemergmed.org/article.asp?issn=2452-2473;year=2024;volume=24;issue=1;spage=33;epage=40;aulast=Shahul |
| _version_ | 1797221253699862528 |
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| author | Irfan Zubair Shahul Hameed Darpanarayan Hazra Priya Ganesan Abhilash Kundavaram Paul Prabhakar |
| author_facet | Irfan Zubair Shahul Hameed Darpanarayan Hazra Priya Ganesan Abhilash Kundavaram Paul Prabhakar |
| author_sort | Irfan Zubair Shahul Hameed |
| collection | DOAJ |
| description | OBJECTIVES: In the context of acute hypoxemic respiratory failure (AHRF), ensuring effective preoxygenation and apneic oxygenation emerges as the pivotal approach ensuring for averting hypoxemic adverse events during endotracheal intubation. To investigate this, we conducted an open-label randomized controlled trial, aiming to assess the comparative effectiveness of nasopharyngeal high-flow oxygenation in conjunction with Bag-Valve-Mask (BVM) versus standard BVM preoxygenation in patients experiencing AHRF within the emergency department (ED).
METHODS: This prospective single-center, open-labeled, randomized controlled trial enrolled patients aged 18 years and above requiring rapid sequence intubation due to AHRF in the ED. Participants were randomly assigned in a 1:1 ratio to either the intervention arm (involving nasopharyngeal high-flow oxygenation and BVM preoxygenation) or the control arm (involving BVM preoxygenation alone).
RESULTS: A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO2 at 0 min postintubation was 95.5 (80%–99%) versus 89 (76%–98%); z-score: 1.081, P = 0.279 in the intervention and control arm, respectively. The most common postintubation complications included hypoxia (intervention arm: 56.7% vs. control arm: 66.7%) and circulatory/hypoxic arrest (intervention arm: 39.5% vs. control arm: 44.7%). There were no adverse complications in 36.7% (n = 11) of patients in the intervention arm. Despite the best possible medical management, almost half (52.6%) of patients in the intervention arm and 47.4% of patients in the control arm succumbed to their illnesses in the ED.
CONCLUSION: The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation-related adverse effects. |
| first_indexed | 2024-04-24T13:02:30Z |
| format | Article |
| id | doaj.art-012a017f3ee24db4b4e6c1bbcd1df4eb |
| institution | Directory Open Access Journal |
| issn | 2452-2473 |
| language | English |
| last_indexed | 2024-04-24T13:02:30Z |
| publishDate | 2024-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Turkish Journal of Emergency Medicine |
| spelling | doaj.art-012a017f3ee24db4b4e6c1bbcd1df4eb2024-04-05T09:59:34ZengWolters Kluwer Medknow PublicationsTurkish Journal of Emergency Medicine2452-24732024-01-01241334010.4103/tjem.tjem_176_23Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trialIrfan Zubair Shahul HameedDarpanarayan HazraPriya GanesanAbhilash Kundavaram Paul PrabhakarOBJECTIVES: In the context of acute hypoxemic respiratory failure (AHRF), ensuring effective preoxygenation and apneic oxygenation emerges as the pivotal approach ensuring for averting hypoxemic adverse events during endotracheal intubation. To investigate this, we conducted an open-label randomized controlled trial, aiming to assess the comparative effectiveness of nasopharyngeal high-flow oxygenation in conjunction with Bag-Valve-Mask (BVM) versus standard BVM preoxygenation in patients experiencing AHRF within the emergency department (ED). METHODS: This prospective single-center, open-labeled, randomized controlled trial enrolled patients aged 18 years and above requiring rapid sequence intubation due to AHRF in the ED. Participants were randomly assigned in a 1:1 ratio to either the intervention arm (involving nasopharyngeal high-flow oxygenation and BVM preoxygenation) or the control arm (involving BVM preoxygenation alone). RESULTS: A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO2 at 0 min postintubation was 95.5 (80%–99%) versus 89 (76%–98%); z-score: 1.081, P = 0.279 in the intervention and control arm, respectively. The most common postintubation complications included hypoxia (intervention arm: 56.7% vs. control arm: 66.7%) and circulatory/hypoxic arrest (intervention arm: 39.5% vs. control arm: 44.7%). There were no adverse complications in 36.7% (n = 11) of patients in the intervention arm. Despite the best possible medical management, almost half (52.6%) of patients in the intervention arm and 47.4% of patients in the control arm succumbed to their illnesses in the ED. CONCLUSION: The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation-related adverse effects.http://www.turkjemergmed.org/article.asp?issn=2452-2473;year=2024;volume=24;issue=1;spage=33;epage=40;aulast=Shahulapneic oxygenationbag-valve-mask preoxygenationhypoxic arrestnasopharyngeal cannulanasopharyngeal high-flow preoxygenationpassive preoxygenationrandomized control trial |
| spellingShingle | Irfan Zubair Shahul Hameed Darpanarayan Hazra Priya Ganesan Abhilash Kundavaram Paul Prabhakar Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial Turkish Journal of Emergency Medicine apneic oxygenation bag-valve-mask preoxygenation hypoxic arrest nasopharyngeal cannula nasopharyngeal high-flow preoxygenation passive preoxygenation randomized control trial |
| title | Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial |
| title_full | Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial |
| title_fullStr | Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial |
| title_full_unstemmed | Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial |
| title_short | Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial |
| title_sort | does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation an open labeled randomized control trial |
| topic | apneic oxygenation bag-valve-mask preoxygenation hypoxic arrest nasopharyngeal cannula nasopharyngeal high-flow preoxygenation passive preoxygenation randomized control trial |
| url | http://www.turkjemergmed.org/article.asp?issn=2452-2473;year=2024;volume=24;issue=1;spage=33;epage=40;aulast=Shahul |
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