Title :

Noninvasive ventilation vs. high-flow nasal cannula oxygen for preoxygenation before intubation in patients with obesity: a post hoc analysis of a randomized controlled trial

Author(s) :

Rodriguez, Maeva [Auteur]
Ragot, Stéphanie [Auteur]
Coudroy, Rémi [Auteur]
Quenot, Jean-Pierre [Auteur]
Vignon, Philippe [Auteur]
Forel, Jean-Marie [Auteur]
Demoule, Alexandre [Auteur]
Mira, Jean-Paul [Auteur]
Ricard, Jean-Damien [Auteur]
Nseir, Saad [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Colin, Gwenhael [Auteur]
Pons, Bertrand [Auteur]
Danin, Pierre-Eric [Auteur]
Devaquet, Jérome [Auteur]
Prat, Gwenael [Auteur]
Merdji, Hamid [Auteur]
Petitpas, Franck [Auteur]
Vivier, Emmanuel [Auteur]
Mekontso-Dessap, Armand [Auteur]
Nay, Mai-Anh [Auteur]
Asfar, Pierre [Auteur]
Dellamonica, Jean [Auteur]
Argaud, Laurent [Auteur]
Ehrmann, Stephan [Auteur]
Fartoukh, Muriel [Auteur]
Girault, Christophe [Auteur]
Robert, René [Auteur]
Thille, Arnaud W. [Auteur]
Frat, Jean-Pierre [Auteur]
Chatellier, Delphine [Auteur]
Boissier, Florence [Auteur]
Veinstein, Anne [Auteur]
Robert, René [Auteur]
Dahyot-Fizelier, Claire [Auteur]
Dargent, Auguste [Auteur]
Large, Audrey [Auteur]
Begot, Emmanuelle [Auteur]
Mancia, Claire [Auteur]
Decavele, Maxence [Auteur]
Dres, Martin [Auteur]
Lehingue, Samuel [Auteur]
Papazian, Laurent [Auteur]
Paul, Marine [Auteur]
Marin, Nathalie [Auteur]
Le Meur, Matthieu [Auteur]
Laissy, Mohammed [Auteur]
Rouzé, Anahita [Auteur]
Henry-Lagarrigue, Matthieu [Auteur]
Yehia, Aihem [Auteur]
Martino, Frédéric [Auteur]
Cerf, Charles [Auteur]
Bailly, Pierre [Auteur]
Helms, Julie [Auteur]
Putegnat, Jean Baptiste [Auteur]
Razazi, Keyvan [Auteur]
Boulain, Thierry [Auteur]
Asfar, Pierre [Auteur]
Cabasson, Séverin [Auteur]
Wallet, Florent [Auteur]
Klouche, Kada [Auteur]
Bellec, Frédéric [Auteur]

Journal title :

Annals of Intensive Care

Abbreviated title :

Ann. Intensive Care

Volume number :

11

Publisher :

Springer Science and Business Media LLC

Publication date :

2021-07-22

ISSN :

2110-5820

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Background Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before ...
Show more >Background Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity. Methods Post hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m−2) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO2/FiO2 < 300 mm Hg). The primary outcome was the occurrence of severe hypoxemia (pulse oximetry < 80%) during the intubation procedure. Results Among the 313 patients included in the original trial, 91 (29%) had obesity with a mean body mass index of 35 ± 5 kg·m−2. Patients with obesity were more likely to experience an episode of severe hypoxemia during intubation procedure than patients without obesity: 34% (31/91) vs. 22% (49/222); difference, 12%; 95% CI 1 to 23%; P = 0.03. Among patients with obesity, 40 received preoxygenation with noninvasive ventilation and 51 with high-flow nasal oxygen. Severe hypoxemia occurred in 15 patients (37%) with noninvasive ventilation and 16 patients (31%) with high-flow nasal oxygen (difference, 6%; 95% CI − 13 to 25%; P = 0.54). The lowest pulse oximetry values during intubation procedure were 87% [interquartile range, 77–93] with noninvasive ventilation and 86% [78–92] with high-flow nasal oxygen (P = 0.98). After multivariable analysis, factors independently associated with severe hypoxemia in patients with obesity were intubation difficulty scale > 5 points and respiratory primary failure as reason for admission. Conclusions Patients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation with noninvasive ventilation may not reduce this risk compared with high-flow nasal oxygen. Trial registration Clinical trial number: NCT02668458 (http://www.clinicaltrials.gov)Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CNRS

Collections :

• Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576

Research team(s) :

Glycobiology in fungal Pathogenesis and Clinical Applications

Submission date :

2024-02-16T13:53:27Z
2024-02-21T09:52:03Z