Simon
Trial question
What is the role of a high-flow nasal cannula for preoxygenation before intubation in patients with hypoxemic respiratory failure?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
45.0% female
55.0% male
N = 40
40 patients (18 female, 22 male).
Inclusion criteria: critically ill subjects with hypoxemic respiratory failure.
Key exclusion criteria: blocked nasopharynx, contraindications for nose-mouth mask or high flow nasal cannula oxygen, expected difficult airway, emergency endotracheal intubation.
Interventions
N=20 high-flow nasal cannula (an Optiflow system for preoxygenation with oxygen flow set to 50 L/min).
N=20 bag-valve-mask (AMBU SPUR II disposable resuscitator for preoxygenation with oxygen flow set at 10 L/min).
Primary outcome
Mean lowest oxygen saturation during intubation
89%
86%
89.0 %
66.8 %
44.5 %
22.3 %
0.0 %
High-flow nasal
cannula
Bag-valve-mask
No significant
difference ↔
No significant difference in mean lowest oxygen saturation during intubation (89% vs. 86%; AD 3%, 95% CI -6.8 to 12.8).
Secondary outcomes
No significant difference in mean duration of intubation (30 s vs. 37 s; AD -7 s, 95% CI -21.51 to 7.51).
Borderline significant increase in hypoxemia, oxygen saturation < 80% (25% vs. 25%).
No significant difference in abortion of apnea phase and emergency intubation due to progressive hypoxemia (10% vs. 5%; AD 5%, 95% CI -10.95 to 20.95).
Safety outcomes
No significant differences in time points before and after intubation concerning oxygen saturation, the ratio of the partial pressure of oxygen and FiO2, and pCO2.
Conclusion
In critically ill subjects with hypoxemic respiratory failure, high-flow nasal cannula was not superior to bag-valve-mask with respect to mean lowest oxygen saturation during intubation.
Reference
Marcel Simon, Christian Wachs, Stephan Braune et al. High-Flow Nasal Cannula Versus Bag-Valve-Mask for Preoxygenation Before Intubation in Subjects With Hypoxemic Respiratory Failure. Respir Care. 2016 Sep;61(9):1160-7.
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