Noninvasive ventilation support during fiberoptic bronchoscopy-guided nasotracheal intubation effectively prevents severe hypoxemia

Lingbo Nong; Weibo Liang; Yuheng Yu; Yin Xi; Dongdong Liu; Jie Zhang; Jing Zhou; Chun Yang; Weiqun He; Xiaoqing Liu; Yimin Li; Rongchang Chen

doi:10.1016/j.jcrc.2019.10.017

Noninvasive ventilation support during fiberoptic bronchoscopy-guided nasotracheal intubation effectively prevents severe hypoxemia

J Crit Care. 2020 Apr:56:12-17. doi: 10.1016/j.jcrc.2019.10.017. Epub 2019 Nov 14.

Authors

Lingbo Nong¹, Weibo Liang¹, Yuheng Yu¹, Yin Xi¹, Dongdong Liu¹, Jie Zhang¹, Jing Zhou¹, Chun Yang¹, Weiqun He¹, Xiaoqing Liu¹, Yimin Li¹, Rongchang Chen²

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Electronic address: chenrc@vip.163.com.

Abstract

Purpose: This study investigated the feasibility and efficacy of continuous noninvasive ventilation (NIV) support with 100% oxygen using a specially designed face mask, for reducing desaturation during fiberoptic bronchoscopy (FOB)-guided intubation in critically ill patients with respiratory failure.

Materials and methods: This was a single-center prospective randomized study. All patients undergoing FOB-guided nasal tracheal intubation were randomized to bag-valve-mask ventilation or NIV for preoxygenation followed by intubation. The NIV group were intubated through a sealed hole in a specially designed face mask during continuous NIV support with 100% oxygen. Control patients were intubated with removal of the mask and no ventilatory support.

Results: We enrolled 106 patients, including 53 in each group. Pulse oxygen saturation (SpO₂) after preoxygenation (99% (96%-100%) vs. 96% (90%-99%), p = .001) and minimum SpO₂ during intubation (95% (87%-100%) vs. 83% (74%-91%), p < .01) were both significantly higher in the NIV compared with the control group. Severe hypoxemic events (SpO₂ < 80%) occurred less frequently in the NIV group than in controls (7.4% vs. 37.7%, respectively; p < .01).

Conclusions: Continuous NIV support during FOB-guided nasal intubation can prevent severe desaturation during intubation in critically ill patients with respiratory failure.

Trial registration: ClinicalTrials.gov, NCT02462668. Registered on 25 May 2015, https://www.clinicaltrials.gov/ct2/results?term=NCT02462668.

Keywords: Fiberoptic bronchoscopy; Intubation; Noninvasive ventilation; Preoxygenation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Bronchoscopy*
Critical Illness
Female
Fiber Optic Technology*
Humans
Hypoxia / prevention & control*
Hypoxia / therapy*
Intubation, Intratracheal / methods*
Male
Middle Aged
Noninvasive Ventilation*
Oxygen
Prospective Studies
Respiration, Artificial
Respiratory Insufficiency
Treatment Outcome

Substances

Oxygen

Associated data

ClinicalTrials.gov/NCT02462668