Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis

Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano, Andrea Cortegiani, Vincenzo Russotto, Cesare Gregoretti, Andrea Cortegiani, Antonino Giarratano, Santi Maurizio Raineri, Vincenzo Russotto

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26 Citations (Scopus)

Abstract

To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation.METHODS:We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control.RESULTS:Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients). Three of these studies investigated high-flow nasal cannula (HFNC) for ApOx while standard nasal cannula was used in one. Globally, ApOx was associated with higher minimum SpO2 value compared to those receiving ETI without ApOx (mean difference 2.31%, 95% CI 0.42 to 4.20, p=0.02, I2=0%) but there were not significant differences between groups in severe hypoxemia and intubation related - complications. Concerning other techniques, noninvasive ventilation (NIV) was compared to bag-valve mask in only one RCT and it reduced the degree of desaturation.CONCLUSIONS:ApOx was significantly associated with higher minimum SpO2 registered during the intubation procedure. Further studies are needed to increase the number of included patients and demonstrate the benefit of ApOx and of other respiratory support methods (e.g. NIV, HFNC).
Original languageEnglish
Pages (from-to)98-106
Number of pages9
JournalJournal of Critical Care
Volume41
Publication statusPublished - 2017

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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