Need for Intubation, Oxygenation Before and During Intubation
Conditions
Keywords
tracheal intubation, preoxygenation, desaturation, hypoxemia, oxygen therapy, high flow nasal cannula oxygen therapy
Brief summary
Tracheal intubation of critically ill patients is associated in the intensive care unit (ICU) with significant complications and morbidity. Patient desaturation is one of the most common complications that may lead to cardiac arrest despite pre-intubation oxygenation. Preoxygenation can be improved by the use of non-invasive ventilation, but this technique can be cumbersome to implement in the context of urgent intubation and more importantly it does not insure oxygenation during intubation. High flow nasal cannula oxygen therapy is a technique that has been shown to improve patient oxygenation in the context of acute hypoxemic respiratory failure. It bears the potential to be of clinical benefit in the setting of tracheal intubation in the ICU to ensure patient safety. The purpose of this study is to compare pre- and per-intubation (during intubation) oxygenation with either a conventional high FiO2 oxygen bag reservoir facemask (current standard practice) or high flow nasal cannula oxygen therapy (new practice to be implemented in our ICU).
Detailed description
Pre-oxygenation is ensured in our ICU with a high FiO2 nonrebreathing facemask, except in patients already under high flow nasal cannula oxygen therapy because of acute hypoxemic respiratory failure. A nasal catheter is positioned to ensure a low oxygen flow during laryngoscopy. Whether or not all patients should benefit from high flow nasal cannula oxygen therapy for pre-oxygenation remains unknown. In order to improve quality of care delivered to our patients and in anticipation of a change in our practice, we decided to record prospectively oxygen parameters during and immediately of intubation using a facemask and to compare them with parameters obtained in patients intubated after our change in practice. The change of practice consists in the systematic use of high flow nasal cannula oxygen therapy to ensure pre and during procedure (tracheal intubation)oxygenation.
Interventions
None listed
Sponsors
Hôpital Louis Mourier
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ICU patient requiring tracheal intubation
Exclusion criteria
* age \< 18 years * cardiac arrest * acute respiratory failure requiring immediate high flow nasal cannula oxygen, defined as patient with SpO2 \< 95% while under 15 L:min oxygen with a nonrebreathing facemask
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| pulse oxymetry after preoxygenation | 3min prexoxygenation |
| lowest pulse oxymetry (SpO2) during intubation | from beginning of laryngoscopy to completed intubation |
| mean pulse oxymetry during intubation | from beginning of laryngoscopy to completed intubation |
| pulse oxymetry after intubation | at connection of the patient to the ventilator |
Secondary
| Measure | Time frame |
|---|---|
| number of pulse oxymetry below 80% | from laryngoscopy to 30 minutes once tracheal intubation completed |
| mean pulse oxymetry | one, five and thirty minutes after intubation |
| number of pulse oxymetry below 90% | from laryngoscopy to 30 minutes once tracheal intubation completed |
Other
| Measure | Time frame |
|---|---|
| hemodynamic instability defined as arterial systolic blood pressure below 80 mmHg | during and immediately after procedure |
| cardiac arrest | during and immediately after procedure |
Countries
France
Outcome results
None listed