{"title":"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。","authors":"Irfan Zubair Shahul Hameed, Darpanarayan Hazra, Priya Ganesan, Abhilash Kundavaram Paul Prabhakar","doi":"10.4103/tjem.tjem_176_23","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>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).</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO<sub>2</sub> at 0 min postintubation was 95.5 (80%-99%) versus 89 (76%-98%); z-score: 1.081, <i>P</i> = 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% (<i>n</i> = 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.</p><p><strong>Conclusion: </strong>The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation-related adverse effects.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"33-40"},"PeriodicalIF":1.1000,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852139/pdf/","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Irfan Zubair Shahul Hameed, Darpanarayan Hazra, Priya Ganesan, Abhilash Kundavaram Paul Prabhakar\",\"doi\":\"10.4103/tjem.tjem_176_23\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>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).</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO<sub>2</sub> at 0 min postintubation was 95.5 (80%-99%) versus 89 (76%-98%); z-score: 1.081, <i>P</i> = 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% (<i>n</i> = 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.</p><p><strong>Conclusion: </strong>The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation-related adverse effects.</p>\",\"PeriodicalId\":46536,\"journal\":{\"name\":\"Turkish Journal of Emergency Medicine\",\"volume\":\"24 1\",\"pages\":\"33-40\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-01-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852139/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Turkish Journal of Emergency Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/tjem.tjem_176_23\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Turkish Journal of Emergency Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/tjem.tjem_176_23","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
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.
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.
期刊介绍：
The Turkish Journal of Emergency Medicine (Turk J Emerg Med) is an International, peer-reviewed, open-access journal that publishes clinical and experimental trials, case reports, invited reviews, case images, letters to the Editor, and interesting research conducted in all fields of Emergency Medicine. The Journal is the official scientific publication of the Emergency Medicine Association of Turkey (EMAT) and is printed four times a year, in January, April, July and October. The language of the journal is English. The Journal is based on independent and unbiased double-blinded peer-reviewed principles. Only unpublished papers that are not under review for publication elsewhere can be submitted. The authors are responsible for the scientific content of the material to be published. The Turkish Journal of Emergency Medicine reserves the right to request any research materials on which the paper is based. The Editorial Board of the Turkish Journal of Emergency Medicine and the Publisher adheres to the principles of the International Council of Medical Journal Editors, the World Association of Medical Editors, the Council of Science Editors, the Committee on Publication Ethics, the US National Library of Medicine, the US Office of Research Integrity, the European Association of Science Editors, and the International Society of Managing and Technical Editors.
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