Efficacy of High Flow Nasal Cannula Oxygen to Reduce Desaturation During Tracheal Intubation

Completed

• Conditions: Need for Intubation; Oxygenation Before and During Intubation

• Registration Number: NCT01699880
• Lead Sponsor: Hôpital Louis Mourier

Brief Summary

Tracheal intubation of critically ill patients is associated in the intensive care unit (ICU) with significant complications and morbidity. Patient desaturation is one of the most common complications that may lead to cardiac arrest despite pre-intubation oxygenation. Preoxygenation can be improved by the use of non-invasive ventilation, but this technique can be cumbersome to implement in the context of urgent intubation and more importantly it does not insure oxygenation during intubation. High flow nasal cannula oxygen therapy is a technique that has been shown to improve patient oxygenation in the context of acute hypoxemic respiratory failure. It bears the potential to be of clinical benefit in the setting of tracheal intubation in the ICU to ensure patient safety. The purpose of this study is to compare pre- and per-intubation (during intubation) oxygenation with either a conventional high FiO2 oxygen bag reservoir facemask (current standard practice) or high flow nasal cannula oxygen therapy (new practice to be implemented in our ICU).

Detailed Description

Pre-oxygenation is ensured in our ICU with a high FiO2 nonrebreathing facemask, except in patients already under high flow nasal cannula oxygen therapy because of acute hypoxemic respiratory failure. A nasal catheter is positioned to ensure a low oxygen flow during laryngoscopy. Whether or not all patients should benefit from high flow nasal cannula oxygen therapy for pre-oxygenation remains unknown. In order to improve quality of care delivered to our patients and in anticipation of a change in our practice, we decided to record prospectively oxygen parameters during and immediately of intubation using a facemask and to compare them with parameters obtained in patients intubated after our change in practice. The change of practice consists in the systematic use of high flow nasal cannula oxygen therapy to ensure pre and during procedure (tracheal intubation)oxygenation.

Study Timeline

• Study Start: 2011-03
• Study First Submitted: 2012-10-01
• Study First Submitted QC: 2012-10-03
• Study First Posted: 2012-10-04
• Primary Completion: 2012-11
• Study Completion: 2013-01
• Status Verified: 2014-08
• Last Update Submitted: 2014-08-11
• Last Update Posted: 2014-08-12

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 101

Inclusion Criteria

• ICU patient requiring tracheal intubation

Exclusion Criteria

• age < 18 years
• cardiac arrest
• acute respiratory failure requiring immediate high flow nasal cannula oxygen, defined as patient with SpO2 < 95% while under 15 L:min oxygen with a nonrebreathing facemask

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
pulse oxymetry after intubation	at connection of the patient to the ventilator
lowest pulse oxymetry (SpO2) during intubation	from beginning of laryngoscopy to completed intubation
mean pulse oxymetry during intubation	from beginning of laryngoscopy to completed intubation
pulse oxymetry after preoxygenation	3min prexoxygenation

Secondary Outcome Measures

Name	Time	Method
mean pulse oxymetry	one, five and thirty minutes after intubation
number of pulse oxymetry below 90%	from laryngoscopy to 30 minutes once tracheal intubation completed
number of pulse oxymetry below 80%	from laryngoscopy to 30 minutes once tracheal intubation completed

Trial Locations

Locations (1)

Medico-surgical ICU; 🇫🇷 Colombes, France