The best modality of pre-oxygenation between high-flow nasal cannula and non-invasive ventilation during intubation of acute hypoxemic respiratory failure patients

Abstract

Background
Severe hypoxemia (SpO2 < 80%) is a common complication occurring during the procedure of intubation in the ICU, which requires preoxygenation in order to secure sufficient time for endotracheal intubation.


Aim of work
To compare strategies of pre-oxygenation carried out by non-invasive ventilation (NIV) versus high-flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure needing intubation in the ICU in terms of the prevention of severe hypoxemia during intubation.


Methods
We conducted an interventional randomized study on 60 patients with type I respiratory failure, divided into two groups: HFNC and NIV groups, monitored for occurrence of severe hypoxemia during intubation, degree of oxygenation improvement during pre-oxygenation, complications during intubation, mechanical ventilation duration, ICU length of stay, and 28-day mortality.


Results

The study population had a mean age of 61.78 ± 16.11 years. Episodes of severe hypoxia during intubation occurred significantly less in the HFNC group compared with the NIV group, 26.1% vs. 60%, respectively (
p
-value = 0.025). The lowest value of oxygen saturation by pulse oximetry was significantly higher in the HFNC group compared with the NIV, 83% vs. 77%, respectively (
P
-value = 0.013). There was no significant difference in incidence of complications and mortality between the two groups.



Conclusions
The use of HFNC in pre-oxygenation is superior to NIV in preventing severe hypoxemia during intubation in patients with hypoxemic respiratory failure but did not affect overall outcome and mortality.