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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2018

01-08-2018 | Review Article/Brief Review

Does apneic oxygenation prevent desaturation during emergency airway management? A systematic review and meta-analysis

Authors: Edmund Tan, MD, Osama Loubani, MD, Nelofar Kureshi, MBBS, Robert S. Green, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 8/2018

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Résumé

Objectif

L’oxygénation apnéique (OA) par lunettes nasales est une méthode de prévention de la désaturation en oxygène au cours des intubations en urgence. L’objectif de cette revue systématique était de déterminer l’efficacité de l’OA sur la prévention de la désaturation en oxygène au cours des intubations en urgence.

Source

Des recherches systématiques ont été effectuées dans trois bases de données électroniques (MEDLINE, EMBASE et CINAHL) pour identifier les études portant sur la prévention de la désaturation en oxygène au moyen de l’OA par lunettes nasales. Notre critère d’évaluation principal était l’incidence des désaturations telle que définie dans chaque étude; nous avons ensuite évalué l’incidence de la désaturation sévère en oxygène (SpO2 < 80%). Une méta-analyse a été effectuée sur les études présentant des données sur la désaturation en oxygène telle que définie par chaque étude et chez des patients ayant une désaturation sévère pour générer une estimation groupée de l’effet.

Constatations principales

Au total, 544 études ont été examinées, parmi lesquelles dix (2 322 patients) satisfaisaient tous les critères d’éligibilité. Comparativement à l’absence d’OA, l’utilisation de cette méthode a été associée à une réduction de la désaturation en oxygène (risque relatif [RR] : 0,76; intervalle de confiance à 95% [IC] : 0,61 à 0,95; P = 0,02), mais n’a pas été associée à une réduction de la désaturation sévère (RR, 0,65; IC à 95% : 0,38 à 1,11; P = 0,12). Néanmoins, il y avait une hétérogénéité significative des facteurs liés aux patients, des interventions et des définitions de la désaturation en oxygène entre les études.

Conclusion

Nos constatations suggèrent que l’OA par lunettes nasales est associée à un moindre risque de désaturation en oxygène au cours des intubations en urgence. Cependant, compte de tenu de l’hétérogénéité des études, d’autres essais de grande qualité sont nécessaires pour déterminer quels patients pourraient bénéficier de l’OA au cours des intubations d’urgence.
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Literature
1.
Bodily JB, Webb HR, Weiss SJ, Braude DA. Incidence and duration of continuously measured oxygen desaturation during emergency department intubation. Ann Emerg Med 2016; 67: 389-95.CrossRefPubMed
2.
Gebremedhn EG, Mesele D, Aemero D, Alemu E. The incidence of oxygen desaturation during rapid sequence induction and intubation. World J Emerg Med 2014; 5: 279-85.CrossRefPubMedPubMedCentral
3.
Helm M, Kremers G, Lampl L, Hossfeld B. Incidence of transient hypoxia during pre-hospital rapid sequence intubation by anaesthesiologists. Acta Anaesthesiol Scand 2013; 57: 199-205.CrossRefPubMed
4.
Nakstad AR, Heimdal HJ, Strand T, Sandberg M. Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service. Am J Emerg Med 2011; 29: 639-44.CrossRefPubMed
5.
Silverberg MJ, Li N, Acquah SO, Kory PD. Comparison of video laryngoscopy versus direct laryngoscopy during urgent endotracheal intubation: a randomized controlled trial. Crit Care Med 2015; 43: 636-41.CrossRefPubMed
6.
7.
Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118: 251-70.CrossRefPubMed
8.
Jaber S, Jung B, Corne P, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med 2010; 36: 248-55.CrossRefPubMed
9.
Cook TM, Woodall N, Harper J. Benger J; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 2011; 106: 632-42.CrossRefPubMed
10.
Patel A, Nouraei SA. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia 2015; 70: 323-9.CrossRefPubMed
11.
12.
Lee SC. Improvement of gas exchange by apneic oxygenation with nasal prong during fiberoptic intubation in fully relaxed patients. J Korean Med Sci 1998; 13: 582-6.CrossRefPubMedPubMedCentral
13.
Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth 2010; 22: 164-8.CrossRefPubMed
14.
Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med 2015; 43: 574-83.CrossRefPubMed
15.
Sakles JC, Mosier JM, Patanwala AE, Dicken JM. Apneic oxygenation is associated with a reduction in the incidence of hypoxemia during the RSI of patients with intracranial hemorrhage in the emergency department. Intern Emerg Med 2016; 11: 983-92.CrossRefPubMed
16.
Vourc’h M, Asfar P, Volteau C, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med 2015; 41: 1538-48.
17.
Semler MW, Janz DR, Lentz RJ, et al. Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. Am J Respir Crit Care Med 2016; 193: 273-80.CrossRefPubMedPubMedCentral
18.
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1.CrossRefPubMedPubMedCentral
19.
Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med 2008; 34: 1835-42.CrossRefPubMed
20.
Marsch SC, Steiner L, Bucher E, et al. Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial. Crit Care 2011; 15: R199.CrossRefPubMedPubMedCentral
21.
22.
23.
Sterne JA, Harbord RM. Funnel plots in meta-analysis. The Stata Journal 2004; 4: 127-41.
24.
von Hippel PT. The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med Res Methodol 2015; 15: 35.CrossRef
25.
Sakles JC, Mosier JM, Patanwala AE, Arcaris B, Dicken JM. First pass success without hypoxemia is increased with the use of apneic oxygenation during rapid sequence intubation in the emergency department. Acad Emerg Med 2016; 23: 703-10.CrossRefPubMed
26.
Dyett JF, Moser MS, Tobin AE. Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne. Anaesth Intensive Care 2015; 43: 577-86.PubMed
27.
Simon M, Wachs C, Braune S, de Heer G, Frings D, Kluge S. High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care 2016; 61: 1160-7.CrossRefPubMed
28.
Caputo N, Azan B, Domingues R, et al. Emergency department use of apneic oxygenation versus usual care during rapid sequence intubation: a randomized controlled trial (The ENDAO Trial). Acad Emerg Med 2017; 24: 1387-94.CrossRefPubMed
29.
Wimalasena Y, Burns B, Reid C, Ware S, Habig K. Apneic oxygenation was associated with decreased desaturation rates during rapid sequence intubation by an Australian helicopter emergency medicine service. Ann Emerg Med 2015; 65: 371-6.CrossRefPubMed
30.
Riyapan S, Lubin J. Apneic oxygenation may not prevent severe hypoxemia during rapid sequence intubation: a retrospective helicopter emergency medical service study. Air Med J 2016; 35: 365-8.CrossRefPubMed
31.
Mort TC. The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA guidelines in the remote location. J Clin Anesth 2004; 16: 508-16.CrossRefPubMed
32.
Perbet S, De Jong A, Delmas J, et al. Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study. Crit Care 2015; 19: 257.CrossRefPubMedPubMedCentral
33.
34.
Eger EI, Severinghaus JW. The rate of rise of PaCO2 in the apneic anesthetized patient. Anesthesiology 1961; 22: 419-25.CrossRefPubMed
35.
Gentz BA, Shupak RC, Bhatt SB, Bay C. Carbon dioxide dynamics during apneic oxygenation: the effects of preceding hypocapnia. J Clin Anesth 1998; 10: 189-94.CrossRefPubMed
36.
Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med 2012; 59(165–75): e1.
37.
38.
Sinclair RC, Luxton MC. Rapid sequence induction. Continuing Education in Anaesthesia Crit Care Pain 2005; 5: 45-8.CrossRef
39.
40.
Efthimiou O, Mavridis D, Debray T, et al. Combining randomized and non-randomized evidence in network meta-analysis. Stat Med 2017; 36: 1210-26.CrossRefPubMed
41.
Navarese EP, Koziński M, Pafundi T, et al. Practical and updated guidelines on performing meta-analyses of non-randomized studies in interventional cardiology. Cardiol J 2011; 18: 3-7.PubMed
42.
Shrier I, Boivin JF, Steele RJ, et al. Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. Am J Epidemiol 2007; 166: 1203-9.CrossRefPubMed
43.
Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Bond E, White LD. Apneic oxygenation during intubation in the emergency department and during retrieval: a systematic review and meta-analysis. Am J Emerg Med 2017; 35: 1542-6.CrossRefPubMed
44.
Binks MJ, Holyoak RS, Melhuish TM, et al. Apnoeic oxygenation during intubation in the intensive care unit: a systematic review and meta-analysis. Heart Lung 2017; 46: 452-7.CrossRefPubMed
45.
Holyoak RS, Melhuish TM, Vlok R, Binks M, White LD. Intubation using apnoeic oxygenation to prevent desaturation: a systematic review and meta-analysis. J Crit Care 2017; 41: 42-8.CrossRefPubMed
46.
e Silva LO, Cabrera D, Barrionueva P, et al. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Ann Emerg Med 2017; 70: 483-94.e11.
47.
Russotto V, Cortegiani A, Raineri SM, Gregoretti C, Giarratano A. Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: a systematic review and meta-analysis. J Crit Care 2017; 41: 98-106.CrossRefPubMed
Metadata
Title
Does apneic oxygenation prevent desaturation during emergency airway management? A systematic review and meta-analysis
Authors
Edmund Tan, MD
Osama Loubani, MD
Nelofar Kureshi, MBBS
Robert S. Green, MD
Publication date
01-08-2018
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 8/2018
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-018-1124-0

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