Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill.
Am J Respir Crit Care Med. 2015 Oct 1;
Authors: Semler MW, Janz DR, Lentz RJ, Matthews DT, Norman BC, Assad TR, Keriwala RD, Ferrell BA, Noto MJ, McKown AC, Kocurek EG, Warren MA, Huerta LE, Rice TW, FELLOW Investigators and the Pragmatic Critical Care Research Group
Abstract
RATIONALE: Hypoxemia is common during endotracheal intubation of critically ill patients and may predispose to cardiac arrest and death. Administration of supplemental oxygen during laryngoscopy (apneic oxygenation) may prevent hypoxemia.
OBJECTIVES: To determine if apneic oxygenation increases the lowest arterial oxygen saturation experienced by patients undergoing endotracheal intubation in the intensive care unit.
METHODS: A randomized, open-label, pragmatic trial in which 150 adults undergoing endotracheal intubation in a medical intensive care unit were randomized to receive 15 L/min of 100% oxygen via high-flow nasal cannula during laryngoscopy (apneic oxygenation) or no supplemental oxygen during laryngoscopy (usual care). The primary outcome was lowest arterial oxygen saturation between induction and two minutes after completion of endotracheal intubation.
MEASUREMENTS AND MAIN RESULTS: Median lowest arterial oxygen saturation was 92% with apneic oxygenation versus 90% with usual care (95% confidence interval for the difference -1.6% to 7.4%; P = .16). There was no difference between apneic oxygenation and usual care in incidence of oxygen saturation < 90% (44.7% versus 47.2%; P = .87), oxygen saturation < 80% (15.8% versus 25.0%; P = .22), or decrease in oxygen saturation > 3% (53.9% versus 55.6%; P = .87). Duration of mechanical ventilation, intensive care unit length of stay, and in-hospital mortality were similar between study groups.
CONCLUSIONS: Apneic oxygenation does not appear to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared to usual care. These findings do not support routine use of apneic oxygenation during endotracheal intubation of critically ill adults. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02051816.
PMID: 26426458 [PubMed - as supplied by publisher]