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

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.

Conflict of interest statement

Declaration of Competing Interest None.

Copyright © 2019. Published by Elsevier Inc.

Figures

Fig. 1
Fig. 1
Flow chart of patient enrollment, randomization, and interventions.
Fig. 2
Fig. 2
Photograph showing intubation during noninvasive face-mask ventilation.
Fig. 3
Fig. 3
Dynamic changes in SpO2 during preoxygenation and nasotracheal intubation (NTI).

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