Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial.

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2024-01-08 eCollection Date: 2024-01-01 DOI:10.4103/tjem.tjem_176_23
Irfan Zubair Shahul Hameed, Darpanarayan Hazra, Priya Ganesan, Abhilash Kundavaram Paul Prabhakar
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引用次数: 0

Abstract

Objectives: In the context of acute hypoxemic respiratory failure (AHRF), ensuring effective preoxygenation and apneic oxygenation emerges as the pivotal approach ensuring for averting hypoxemic adverse events during endotracheal intubation. To investigate this, we conducted an open-label randomized controlled trial, aiming to assess the comparative effectiveness of nasopharyngeal high-flow oxygenation in conjunction with Bag-Valve-Mask (BVM) versus standard BVM preoxygenation in patients experiencing AHRF within the emergency department (ED).

Methods: This prospective single-center, open-labeled, randomized controlled trial enrolled patients aged 18 years and above requiring rapid sequence intubation due to AHRF in the ED. Participants were randomly assigned in a 1:1 ratio to either the intervention arm (involving nasopharyngeal high-flow oxygenation and BVM preoxygenation) or the control arm (involving BVM preoxygenation alone).

Results: A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO2 at 0 min postintubation was 95.5 (80%-99%) versus 89 (76%-98%); z-score: 1.081, P = 0.279 in the intervention and control arm, respectively. The most common postintubation complications included hypoxia (intervention arm: 56.7% vs. control arm: 66.7%) and circulatory/hypoxic arrest (intervention arm: 39.5% vs. control arm: 44.7%). There were no adverse complications in 36.7% (n = 11) of patients in the intervention arm. Despite the best possible medical management, almost half (52.6%) of patients in the intervention arm and 47.4% of patients in the control arm succumbed to their illnesses in the ED.

Conclusion: The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation-related adverse effects.

与标准袋阀面罩预吸氧相比,插管时使用鼻咽插管进行呼吸暂停吸氧是否能改善急性低氧血症呼吸衰竭患者的氧合情况?一项开放标签随机对照试验。
目的:在急性低氧血症呼吸衰竭(AHRF)的情况下,确保有效的预吸氧和呼吸暂停吸氧是避免气管插管期间发生低氧血症不良事件的关键方法。为此,我们进行了一项开放标签随机对照试验,旨在评估在急诊科(ED)内发生 AHRF 的患者中,鼻咽高流量吸氧与袋-活瓣-面罩(BVM)相结合与标准 BVM 预吸氧的比较效果:这项前瞻性、单中心、开放标签、随机对照试验招募了 18 岁及以上因急诊科 AHRF 而需要快速顺序插管的患者。参与者按 1:1 的比例随机分配到干预组(包括鼻咽高流量吸氧和 BVM 预吸氧)或对照组(仅包括 BVM 预吸氧):共有 76 人参加了研究,每组 38 人,分布均匀。干预组和对照组插管后 0 分钟的 SpO2 中位数(四分位数间距 [IQR])分别为 95.5(80%-99%)和 89(76%-98%);z 评分:1.081,P = 0.279。最常见的插管后并发症包括缺氧(干预组:56.7% 对对照组:66.7%)和循环/缺氧骤停(干预组:39.5% 对对照组:44.7%)。干预组中有 36.7% 的患者(n = 11)未出现不良并发症。尽管采取了尽可能好的医疗措施,但仍有近一半(52.6%)的干预组患者和 47.4% 的对照组患者在急诊室病逝:结论:两组患者的主要治疗结果在统计学上没有显著差异。然而,干预组患者的插管相关不良反应较少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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