Oxygen reserve index for non-invasive early hypoxemia detection during endotracheal intubation in intensive care: the prospective observational NESOI study

Annals of Intensive Care

Pauline Lamouche-Wilquin¹  Maelle Martin¹  Jean Reignier¹  Charlotte Garret¹  Hugo Hille¹  Emmanuel Canet¹  Amelie Seguin¹  Arnaud-Felix Miaihle¹  Jeremie Lemarie¹  Jean Morin¹  Olivier Zambon¹  Gregoire Ottavy¹  Laura Crosby¹  Jean-Baptiste Lascarrou²  Aurelie Le Thuaut³ 

[1] Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France;Paris Cardiovascular Research Centre, Université de Paris, INSERM, Paris, France;Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France;Plateforme de Méthodologie Et Biostatistique, Direction de La Recherche de L’Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France;

关键词: Intensive care;    Intubation;    Oxygenation;    Monitoring;   

DOI  :  10.1186/s13613-021-00903-8

来源: Springer

【 摘 要 】

BackgroundTo evaluate the ability of the oxygen reserve index (ORI) to predict the occurrence of mild hypoxemia (defined as SpO2  <  97%) during endotracheal intubation (ETI) of patients in the intensive care unit (ICU).MethodsThis observational single-centre study included patients without hypoxemia (defined as SpO2/FiO2  >  214) who required ETI in the ICU. Patients were followed during preoxygenation and ETI then until hospital discharge and/or day 28. We recorded cases of mild hypoxemia, moderate (SpO2  <  90%) and severe (SpO2  <  80%) hypoxemia, moderate arterial hypotension (systolic arterial pressure  <  90 mmHg), oesophageal intubation, aspiration, cardiac arrest, and death.ResultsBetween January 2019 and July 2020, 56 patients were included prospectively and 51 patients were analysed. Twenty patients had mild hypoxemia between the end of preoxygenation and the end of intubation; in 10 of these patients, the decrease in SpO2 below 97% was preceded by an ORI  <  0.4, the median time difference being 81 s [interquartile range, 34–146]. By multivariable analysis, a higher ORI (by 0.1 increase) value during preoxygenation was associated with absence of hypoxemia (odds ratio, 0.76; 95% confidence interval, 0.61;0.95; P  =  0.0141).ConclusionIn non-hypoxemic patients, the 81-s [34–146] median time between the ORI decrease below 0.4 and the SpO2 decrease below 97% during apnoea may allow preventive action. A higher ORI value during preoxygenation was independently protective against hypoxemia. Whether these findings also apply to hypoxemic patients, and the clinical impact of a preoxygenation strategy based on ORI monitoring, remain to be evaluated prospectively.Trial Registration ClinicalTrial.gov, #NCT03600181.

【 授权许可】

CC BY