High-Flow Nasal Cannula Versus Bag-Valve-Mask for Preoxygenation Before Intubation in Subjects With Hypoxemic Respiratory Failure.
Respiratory Care · 2016-06-07 · Randomised trial
Abstract
BACKGROUND: Critically ill patients with respiratory failure undergoing intubation have an increased risk of hypoxemia-related complications. Delivering oxygen via a high-flow nasal cannula (HFNC) has theoretical advantages and is increasingly used. This study was conducted to compare HFNC with bag-valve-mask (BVM) for preoxygenation and to assess oxygenation during intubation in subjects with hypoxemic respiratory failure. METHODS: This study was a randomized controlled trial including 40 critically ill subjects with hypoxemic respiratory failure who received either HFNC or BVM for preoxygenation before intubation in the ICU. The primary outcome was the mean lowest SpO2 during intubation. RESULTS: The mean lowest SpO2 during intubation was 89 ± 18% in the HFNC group and 86 ± 11% in the BVM group (P = .56). In subjects receiving HFNC, a significant increase in SpO2 after preoxygenation was only seen in those previously receiving low-flow oxygen (P = .007), whereas there was no significant difference in SpO2 in subjects previously receiving noninvasive ventilation or HFNC (P = .73). During the 1 min of apnea after the induction of anesthesia, SpO2 dropped significantly in the BVM group (P = .001), whereas there was no significant decrease in the HFNC group (P = .17). There were no significant differences between the 2 groups at any of the predefined time points before or after intubation concerning SpO2 , PaO2 /FIO2 , and PaCO2 . CONCLUSIONS: Preoxygenation using HFNC before intubation was feasible and safe compared with BVM in critically ill subjects with acute, mild to moderate hypoxemic respiratory failure. There was no significant difference in the mean lowest SpO2 during intubation between the HFNC and the BVM group. There was also no significant difference in SpO2 between the 2 groups at any of the predefined time points. However, on continuous monitoring, there was a significant decrease in SpO2 during the apnea phase before intubation in the BVM group, which was not seen in the HFNC group. (ClinicalTrials.gov registration NCT01994928.).
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Bag-valve-mask ventilation · High-flow nasal oxygen · Other drugs · Oxygen
Related articles
- High-Flow Nasal Cannula versus Bag Valve Mask for Preoxygenation during Rapid Sequence Intubation in the Emergency Department: A Single-Center, Prospective, Randomized Controlled Trial. (Prehosp Disaster Med, 2024)
- Oxygenation strategies prior to and during prehospital emergency anaesthesia in UK HEMS practice (PREOXY survey). (Scand J Trauma Resusc Emerg Med, 2020)
- [Effect of preoxygenation and apnoeic oxygenation during intubation in the critically ill patients: a network Meta-analysis]. (Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2019)
- Prehospital airway and ventilatory management: a collaborative and narrative review. (Intensive Care Med, 2026)
- Randomized controlled trial to assess the effectiveness of apnoeic oxygenation in adults using a low-flow or high-flow nasal cannula with head side elevation during endotracheal intubation in the emergency department. (BMC Res Notes, 2025)
- Pre-oxygenation using high-flow nasal oxygen vs. tight facemask during rapid sequence induction. (Anaesthesia, 2021)