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Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/1115
Title: Apnoeic oxygenation during intubation in the intensive care unit: A systematic review and meta-analysis
Authors: Binks, MJ
Holyoak, RS
Melhuish, TM
Vlok, R
Hodge, A
Ryan, T
White, LD
ANZCA/FPM Author: White, LD
Keywords: Apnoeic oxygenation
Critical care
Critical desaturation
Hypoxaemia
Intensive care
Intubation
Citation: 46(6):452-457. Epub 2017 Sep 12.
Abstract: Hypoxaemia increases the risk of cardiac arrest and mortality during intubation. The reduced physiological reserve and reduced efficacy of pre-oxygenation in intensive care patients makes their intubation particularly dangerous. Apnoeic oxygenation is a promising means of preventing hypoxaemia in this setting. We sought to ascertain whether apnoeic oxygenation reduces the incidence of hypoxaemia when used during endotracheal intubation in the intensive care unit (ICU). A systematic review of five databases for all relevant studies published up to November 2016 was performed. Eligible studies investigated apnoeic oxygenation during intubation in the ICU, irrespective of design. All studies were assessed for risk of bias and level of evidence. A meta-analysis was performed on all data using Revman 5.3. Six studies including 518 patients were retrieved. The study found level 1 evidence of a significant reduction in the incidence of critical desaturation (RR = 0.69, CI = 0.48-1.00, p = 0.05) and a significant increase in the lowest SpO2 value by 2.83% (CI = 2.28-3.38, p < 0.00001). There was a significant reduction in ICU stay (WMD = -2.89, 95%CI = -3.25 to -2.51, p < 0.00001). There was no significant difference between groups regarding mortality (RR = 0.77, 95%CI = 0.59-1.03, p = 0.08), first pass intubation success (RR = 1.17, 95%CI = 0.67 to 2.03, p = 0.58), arrhythmia during intubation (RR = 0.58, 95%CI = 0.08 to 4.29, p = 0.60), cardiac arrest during intubation (RR = 0.33, 95%CI = 0.01 to 7.84, p = 0.49) and duration of ventilation (WMD = -1.97, 95%CI = -5.89 to 1.95, p = 0.32). Apnoeic oxygenation reduces patient hypoxaemia during intubation performed in the ICU. This meta-analysis found evidence that apnoeic oxygenation may significantly reduce the incidence of critical desaturation and significantly raises the minimum recorded SpO2 in this setting. We recommend apnoeic oxygenation be incorporated into ICU intubation protocol.
URI: http://hdl.handle.net/11055/1115
DOI: 10.1016/j.hrtlng.2017.08.001
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/28912057/
ISSN: 1527-3288
Journal Title: Heart & lung : the journal of critical care
Type: Journal Article
Study/Trial: Case Control Studies
Appears in Collections:Scholarly and Clinical

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