High Flow Nasal Cannula Oxygen for Pre and During Procedure Oxygenation During Tracheal Intubation: Comparison With High FiO2 Non Rebreathing Bag Reservoir Facemasks
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Need for Intubation
- Sponsor
- Hôpital Louis Mourier
- Enrollment
- 101
- Locations
- 1
- Primary Endpoint
- pulse oxymetry after intubation
- Status
- Completed
- Last Updated
- 11 years ago
Overview
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.
Investigators
Prof Jean-Damien RICARD
Professor of Intensive Care Medicine, assistant head of ICU
Hôpital Louis Mourier
Eligibility Criteria
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
Outcomes
Primary Outcomes
pulse oxymetry after intubation
Time Frame: at connection of the patient to the ventilator
lowest pulse oxymetry (SpO2) during intubation
Time Frame: from beginning of laryngoscopy to completed intubation
mean pulse oxymetry during intubation
Time Frame: from beginning of laryngoscopy to completed intubation
pulse oxymetry after preoxygenation
Time Frame: 3min prexoxygenation
Secondary Outcomes
- number of pulse oxymetry below 80%(from laryngoscopy to 30 minutes once tracheal intubation completed)
- 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)