Noninvasive ventilation vs. high-flow nasal cannula oxygen for preoxygenation before intubation in patients with obesity: a post hoc analysis of a randomized controlled trial

Annals of Intensive Care

Alexandre Demoule¹  Jean-Damien Ricard²  Armand Mekontso-Dessap³  Jean-Paul Mira⁴  Muriel Fartoukh⁵  Stephan Ehrmann⁶  Christophe Girault⁷  Gwenhael Colin⁸  Pierre Asfar⁹  Hamid Merdji^1,10  Stéphanie Ragot^1,11  Jean-Marie Forel^1,12  Jean Dellamonica^1,13  Rémi Coudroy^1,14  Jean-Pierre Frat^1,14  Maeva Rodriguez^1,14  René Robert^1,14  Arnaud W. Thille^1,14  Saad Nseir^1,15  Pierre-Eric Danin^1,16  Franck Petitpas^1,17  Philippe Vignon^1,18  Jérome Devaquet^1,19  Jean-Pierre Quenot^2,20  Mai-Anh Nay^2,21  Gwenael Prat^2,22  Laurent Argaud^2,23  Emmanuel Vivier^2,24  Bertrand Pons^2,25 

[1] AP-HP 6, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie Et Réanimation Médicale du Département R3S, Paris, France;INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France;AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 92700, Colombes, France;UMR IAME 1137, Université Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France;INSERM, IAME 1137, 75018, Paris, France;Assistance Publique des Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service Médecine Intensive Réanimation Médicale, 94010, Créteil, France;Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, 94010, Créteil, France;INSERM, Unité UMR 955, IMRB, 94010, Créteil, France;Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire de Paris Centre, Hôpital Cochin, Réanimation médicale, Paris, France;Faculté de Médecine, Université Paris Descartes, Paris, France;Assistance Publique – Hôpitaux de Paris, Hôpital Tenon, Service de Médecine Intensive Réanimation, Sorbonne Université, 75020, Paris, France;CHRU de Tours, Médecine Intensive Réanimation, CIC1415,, CRICS-TriggerSEP Research Network, Tours, France;Centre D’Etudes Des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France;CHU de Rouen, Normandie Univ, UNIROUEN, Department of Medical Intensive Care, Charles Nicolle University, Hospital, Rouen, France;EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, 76000, Rouen, France;Centre Hospitalier Départemental de La Roche Sur Yon, Service de Réanimation Polyvalente, La Roche sur Yon, France;Département de Médecine Intensive-Réanimation, CHU D’Angers, Angers, France;Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Strasbourg, France;INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France;INSERM, CIC-1402, Biostatistics, Université de Poitiers, Faculté de Médecine Et de Pharmacie de Poitiers, Poitiers, France;Médecine Intensive Réanimation Détresses Respiratoires Et Infection Sévères, AP-HM, CHU Nord and CEReSS - Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France;Médecine Intensive Réanimation, CHU de Nice, Nice, France;UR2CA, Université Cote D’Azur, Nice, France;Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France;INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France;Médecine Intensive-Réanimation, CHU de Lille, Inserm U1285, Univ. Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale Et Fonctionnelle, 59000, Lille, France;Réanimation Chirurgicale, CHU de Nice, Nice, France;INSERM U1065, team 8, C3M, Nice, France;Réanimation Chirurgicale, CHU de Poitiers, Poitiers, France;Réanimation Polyvalente, CHU Dupuytren, 87042, Limoges, France;Clinical Investigation Centre INSERM 1435, 87042, Limoges, France;Réanimation polyvalente, Hôpital Foch, Suresnes, France;Service de Médecine Intensive Réanimation, CHU Dijon Bourgogne, Dijon, France;Université Bourgogne Franche-Comté Lipness Team UMR 1231 Et INSERM CIC 1432 Epidémiologie Clinique, Dijon, France;Service de Médecine Intensive Réanimation, Centre Hospitalier Régional D’Orléans, Orléans, France;Service de Réanimation Médicale, CHU de La Cavale Blanche, Brest, France;Service de Réanimation Médicale, Hospices Civils de Lyon, Groupement Hospitalier Universitaire Edouard Herriot, 69003, Lyon, France;Service de Réanimation Polyvalente, Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France;Service de Réanimation, CHU Point-À-Pitre, Pointe-à-Pitre, Guadeloupe, France;

关键词: Preoxygenation;    Intubation;    Non-invasive ventilation;    High-flow oxygen;    Respiratory failure;    Obesity;    Hypoxemia;   

DOI  :  10.1186/s13613-021-00892-8

来源: Springer

【 摘 要 】

BackgroundCritically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity.MethodsPost hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m−2) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO2/FiO2 < 300 mm Hg). The primary outcome was the occurrence of severe hypoxemia (pulse oximetry < 80%) during the intubation procedure.ResultsAmong the 313 patients included in the original trial, 91 (29%) had obesity with a mean body mass index of 35 ± 5 kg·m−2. Patients with obesity were more likely to experience an episode of severe hypoxemia during intubation procedure than patients without obesity: 34% (31/91) vs. 22% (49/222); difference, 12%; 95% CI 1 to 23%; P = 0.03. Among patients with obesity, 40 received preoxygenation with noninvasive ventilation and 51 with high-flow nasal oxygen. Severe hypoxemia occurred in 15 patients (37%) with noninvasive ventilation and 16 patients (31%) with high-flow nasal oxygen (difference, 6%; 95% CI − 13 to 25%; P = 0.54). The lowest pulse oximetry values during intubation procedure were 87% [interquartile range, 77–93] with noninvasive ventilation and 86% [78–92] with high-flow nasal oxygen (P = 0.98). After multivariable analysis, factors independently associated with severe hypoxemia in patients with obesity were intubation difficulty scale > 5 points and respiratory primary failure as reason for admission.ConclusionsPatients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation with noninvasive ventilation may not reduce this risk compared with high-flow nasal oxygen.Trial registration Clinical trial number: NCT02668458 (http://www.clinicaltrials.gov)

【 授权许可】

CC BY