Table.
Studies included in this review that provide evidence for (*) or against (#) the value of apneic oxygenation with nasal cannula to prevent desaturation during intubation. The characteristics of each study are detailed using a PICO (Populations/people/patient/problem Interventions Comparison Outcome) format.
| Study | Patients | Intervention | Comparator | Outcome |
|---|---|---|---|---|
| Binks et al., 2017* | Systematic review and meta analysis of six studies with 1,822 patients requiring intubation | Nasal cannula during intubation | Without nasal cannula during intubation | All but one study showed a significant risk reduction of oxygen desaturation (RR= 0.76, 95%, CI [0.60 to 0.90], p= 0.002) with significant heterogeneity (I2= 80%, p= 0.0005) |
| Caputo et al., 2017# | Randomized controlled trial in 200 ED patients requiring intubation. Patients were allocated to receive apneic oxygenation (n=100) or standard of care (n=100) by pre-determined randomization in a 1:1 ratio. | Nasal cannula during intubation | Standard of care-No supplemental oxygen during Laryngoscopy | There was no difference in lowest mean oxygen saturation between the two groups (92, 95% CI [91 to 93] in AO vs. 93, 95% CI 92 to 94 in standard of care, p=0.11) |
| Pavlov et al., 2017* | Systematic review and meta analysis of eight studies with 1,953 patients requiring intubation | Nasal cannula during intubation | Without nasal cannula during intubation | Apneic oxygenation reduced the relative risk of hypoxemia by 30% (95% CI [0.59 to 0.82]). There was a trend toward lower mortality in the apneic oxygenation group (RR of death 0.77; 95% CI [0.59 to 1.02]) |
| White et al., 2017* | Systematic review and meta analysis of eleven studies with 2,078 patients requiring intubation | Nasal cannula during intubation | Without nasal cannula during intubation | Apneic oxygenation during intubation is associated with a reduced risk of desaturation (RR 0.65, p =0.005) |
| Jaber et al., 2016* | Randomized, controlled, single-center trial with assessor-blinded outcome assessment in 49 patients admitted to the ICU | HFNC [flow = 60 L/min, fraction of inspired oxygen (FiO2) = 100 %] combined with NIV (pressure support = 10 cmH2O, positive end-expiratory pres-sure = 5 cm H2O, FiO2 = 100 %) | NIV (PS of 10 cmH2O, PEEP of 5 cm H2O, FiO2 = 100 %) | SpO2 values were significantly higher in the intervention group than in the reference group [100 (95–100) % vs. 96 (92–99) %, p = 0.029] |
| Riyapan and Lubin, 2016# | Retrospective, case controlled study of 29 pre-hospital patients requiring intubation | Nasal cannula during intubation | Without nasal cannula during intubation | Incidence of SpO2 < 90% during intubation 17.2% vs 21.9% in the control group (p = 0.78) |
| Sakles et al., 2016a* | Observational study of apneic oxygenation on first-pass success without hypoxemia in 635 patients undergoing RSI in the ED | Nasal cannula during intubation | Without nasal cannula during intubation | In the AO cohort the FPS-H was 312/380 (82.1%) |
| Sakles et al., 2016b* | Prospective comparative study of 127 patients with intracranial hemorrhage requiring intubation | Nasal cannula during intubation | Without nasal cannula during intubation | and in the no AO cohort the FPS-H was 176/255 (69.0%)AO was associated with a reduced odds of desaturation (aOR 0.13; 95 % CI [0.03 to 0.53]) |
| Semler et al. 2016# | RCT of 150 ICU patients re-quiring intubation | Nasal cannula during intubation | Without nasal cannula during intubation | Intervention group had an SpO2 level of 99% [IQR=96–100%] before intubation and a low-est SpO2 of 92% during intubation. 60.5% of patients fell <90% SpO2 during intubation. Results were NOT statistically significant |
| Dyett et al., 2015* | Prospective observational study of 129 patients in the emergency department, ICU and on the wards as part of medical emergency response teams care | Nasal cannula during intubation | Without nasal cannula during intubation | Intervention group without respiratory failure had a significant reduction in incidence of hy-poxemia during intubation (0 of 31) |
| Miguel-Montanes et al., 2015* | Prospective quasi-experimental study of 101 patients in ICU requiring intubation | Nasal cannula during intubation | Bag valve mask intermittently during intubation | Intervention group maintained a median SpO2 level of 100% (range 95–100%) before and during intubation |
| Vourc’h et al. 2015# | RCT of 124 patients with Respiratory Failure requiring intubation | Nasal cannula during intubation | High Fraction-Inspired Oxygen Facial Mask during intubation | Intervention group had a mean SpO2 level of 97.1% before intubation and a median SpO2 level of 91.5% during intu-bation [IQR=80–96%]. Results were NOT statisti-cally significant |
| Wimalasena et al., 2015* | Retrospective study of 728 patients requiring intubation by EMS | Nasal cannula during intubation | Without nasal cannula during intubation | Intervention group had a decrease in desaturation rates from 22.6% to 16.5% |
| Ramachandran et al., 2010* | Prospective RCT of 30 obese patients undergoing surgery | Nasal cannula during intubation | Without nasal cannula during intubation | Intervention group fell below 95% SpO2 level at 5.29 min vs 3.49 min in the control |
| Baraka et al., 2007* | RCT of 34 morbidly obese patients undergoing gastric band or bypass surgery | Nasopharyngeal insufflation during intubation | Without nasopharyngeal insufflation | 94% of intervention group maintained an SpO2 level of 100% before and after intubation |
| Taha et al., 2006* | RCT of 30 patients undergoing surgery | Nasal cannula during intubation | Without nasal cannula during | Intervention group maintained an SpO2 level of 100% before and during intubation vs comparator who fell below 95% after 3.65 mins |
| Lee 1998* | RCT of 46 patients undergoing trypanomastoidectomy | Nasal cannula during intubation | Without nasal cannula during intubation | Intervention group had a statistically significant decrease in PaCO2 vs comparator at 3 mins |
| Teller et al., 1988* | Double-blinded, cross-over, RCT of 12 patients undergoing surgery | “Catheter” during intubation | Without “catheter” during intubation | Intervention group maintained an SpO2 level of 97% before and during intubation |
AO, apneic oxygenation; aOR, adjusted odds ratio; CI, confidence interval; ED, emergency department; EMS, emergency medical service; FiO2, fraction of inspired oxygen; FPS-H, first-pass success without hypoxemia; HFNC, high-flow nasal cannula; I2, heterogeneity in meta analysis; ICU, intensive care unit; IQR, interquartile range; NIV, non-invasive ventilation; p, p-value; RCT, randomized control trial; RR, relative risk; SpO2, oxygen saturation.