Comparison of Two Techniques of Peri-Intubation Oxygenation to Minimize the Degree of Desaturation in Patients with Hypoxemic Respiratory Failure in Intensive Care Unit

Abstract

Introduction: Most common complication encountered while intubating critically ill patients in intensive care unit (ICU) is hypoxemia. Acute physiological abnormalities and poor pulmonary reserve render preoxygenation less effective or insufficient to avoid desaturation even for short duration of apnea in these patients. Measures to oxygenate the patient even during the period of apnea should be considered. Objective: To compare Continuous Positive Airway Pressure (CPAP) administered through nasopharyngeal airway and traditional apneic oxygenation administered through nasal prongs, in reducing the drop in oxygen saturation (SpO2 ) while intubating critically ill patients in ICU. Methodology: In this randomized controlled study, 50 patients with type I respiratory failure requiring mechanical ventilation, were randomized into 2 groups of 25 each. After 5 min of NIV preoxygenation, in Group NPA – patients received apneic oxygenation through a nasopharyngeal airway connected to ventilator circuit and CPAP of 10 cmH2 O Group NC – patients received oxygen via nasal prongs at 15 l/min during intubation. The SpO2 levels at various time intervals of per‑intubation period were recorded. Results: Significant difference was observed in degree of desaturation between the 2 groups (2.1 ± 3.5 in group NPA versus 4.24 ± 3.67 in group NC, P value 0.007). The mean tracheal intubation time (44.93 ± 19.66 vs 46.79 ± 18, P value 0.739) and mean intubation difficulty scores (IDS) (1.67 ± 1.39 vs 1.47 ± 1.35, P value 0.464) were comparable in both the groups. Conclusion: The degree of desaturation while intubating hypoxemic patients in ICU is similar with both the techniques of peri‑intubation oxygenation, i.e., Oxygen administered though nasal Prongs at 15 L/min and CPAP of 10 cmH2 O administered through nasopharyngeal airway. Cinical Trial Registration No. CTRI/2018/09/015747 Registered at www.ctri.gov.in.