12230Georgetown University School of Medicine, Washington, DC, USA.
12328Vanderbilt University Medical Center, Nashville, TN, USA.
J Intensive Care Med. 2022 Jul;37(7):899-907. doi: 10.1177/08850666211058646. Epub 2021 Dec 13.
Hypoxemia is common during tracheal intubation in intensive care units. To prevent hypoxemia during intubation, 2 methods of delivering oxygen between induction and laryngoscopy have been proposed: bag-mask ventilation and supplemental oxygen delivered by nasal cannula without ventilation (apneic oxygenation). Whether one of these approaches is more effective for preventing hypoxemia during intubation of critically ill patients is unknown. We performed a secondary analysis of data from 138 patients enrolled in 2, consecutive randomized trials of airway management in an academic intensive care unit. A total of 61 patients were randomized to receive bag-mask ventilation in a trial comparing bag-mask ventilation to none, and 77 patients were randomized to receive 100% oxygen at 15 L/min by nasal cannula in a trial comparing apneic oxygenation to none. Using multivariable linear regression accounting for age, body mass index, severity of illness, and oxygen saturation at induction, we compared patients assigned to bag-mask ventilation with those assigned to apneic oxygenation regarding lowest oxygen saturations from induction to 2 min after intubation. Patients assigned to bag-mask ventilation and apneic oxygenation were similar at baseline. The median lowest oxygen saturation was 96% (interquartile range [IQR] 89%-100%) in the bag-mask ventilation group and 92% (IQR 84%-99%) in the apneic oxygenation group. After adjustment for prespecified confounders, bag-mask ventilation was associated with a higher lowest oxygen saturation compared to apneic oxygenation (mean difference, 4.2%; 95% confidence interval, 0.7%-7.8%; = .02). The incidence of severe hypoxemia (oxygen saturation<80%) was 6.6% in the bag-mask ventilation group and 15.6% in the apneic oxygenation group (adjusted odds ratio, 0.33; = .09). This secondary analysis of patients assigned to bag-mask ventilation and apneic oxygenation during 2 clinical trials suggests that bag-mask ventilation is associated with higher oxygen saturation during intubation compared to apneic oxygenation.
低氧血症在重症监护病房气管插管过程中很常见。为了防止插管过程中的低氧血症，已经提出了在诱导和喉镜检查之间输送氧气的 2 种方法：气囊面罩通气和无通气时通过鼻导管输送补充氧气（无通气氧合）。在这两种方法中，哪一种更能有效地预防危重病患者插管期间的低氧血症尚不清楚。
我们对在学术性重症监护病房进行的 2 项连续气道管理随机试验中纳入的 138 例患者的数据进行了二次分析。在比较气囊面罩通气与无通气的试验中，共有 61 例患者被随机分配接受气囊面罩通气，在比较无通气氧合与无通气氧合的试验中，77 例患者被随机分配接受 15 L/min 的 100%氧气通过鼻导管输送。使用多变量线性回归法，根据年龄、体重指数、疾病严重程度和诱导时的氧饱和度，比较了被分配接受气囊面罩通气的患者与被分配接受无通气氧合的患者，比较了从诱导到插管后 2 分钟之间的最低氧饱和度。
在基线时，被分配接受气囊面罩通气和无通气氧合的患者相似。气囊面罩通气组的最低氧饱和度中位数为 96%（四分位距[IQR] 89%-100%），无通气氧合组为 92%（IQR 84%-99%）。在调整了预先指定的混杂因素后，与无通气氧合相比，气囊面罩通气与更高的最低氧饱和度相关（平均差异，4.2%；95%置信区间，0.7%-7.8%； = .02）。气囊面罩通气组严重低氧血症（氧饱和度<80%）的发生率为 6.6%，无通气氧合组为 15.6%（校正优势比，0.33； = .09）。
这项对 2 项临床试验中被分配接受气囊面罩通气和无通气氧合的患者的二次分析表明，与无通气氧合相比，气囊面罩通气在插管过程中与更高的氧饱和度相关。
