La Via Luigi, Cuttone Giuseppe, Senussi Testa Tarek, Duarte-Medrano Gilberto, Nuno-Lambarri Natalia, Deana Cristian, Maniaci Antonino, Paternò Daniele Salvatore, Zdravkovic Ivana, Sorbello Massimiliano
Department of Anesthesia and Intensive Care 1, University Hospital Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy.
Trauma Center Unit, "Villa Sofia-Cervello" Hospital, 90146 Palermo, Italy.
J Clin Med. 2025 Jul 29;14(15):5356. doi: 10.3390/jcm14155356.
Pre-oxygenation is the key step prior to endotracheal intubation, particularly in a critically ill patient, to prevent life-threatening peri-procedural hypoxemia. This narrative review explores the emerging interest of Non-Invasive Positive Pressure Ventilation (NIPPV) as a pre-oxygenation modality in the intensive care unit (ICU) context. We reviewed data from randomized controlled trials (RCTs) and observational studies published from 2000 to 2024 that compare NIPPV to conventional oxygen therapy and High Flow Nasal Cannula Oxygen (HFNCO). The pathophysiological mechanisms for the successful use of NIPPV, including alveolar recruitment, the decrease of shunting, and the maintenance of functional residual capacity, were reviewed in depth. Existing studies show that NIPPV significantly prolongs the apnea time, reduces the rate of peri-intubation severe hypoxaemia in selected patients and is especially effective for patients with acute hypoxaemic respiratory failure. Nevertheless, appropriate patient selection is still crucial because some diseases can contraindicate or even be harmful with NIPPV. We further discussed the practical aspects of how to use this ventilatory support (the best ventilator settings, which interface, and when to apply it). We lastly discuss unanswered questions and offer suggestions and opportunities for future exploration in guiding the role of NIPPV use in the pre-oxygenation of the critically ill patient requiring emergent airway management.
预充氧是气管插管前的关键步骤，对于危重症患者尤为重要，可预防危及生命的围手术期低氧血症。本叙述性综述探讨了无创正压通气（NIPPV）作为重症监护病房（ICU）环境中预充氧方式的新应用。我们回顾了2000年至2024年发表的随机对照试验（RCT）和观察性研究的数据，这些研究比较了NIPPV与传统氧疗和高流量鼻导管吸氧（HFNCO）。深入回顾了成功使用NIPPV的病理生理机制，包括肺泡复张、分流减少和功能残气量的维持。现有研究表明，NIPPV可显著延长呼吸暂停时间，降低特定患者围插管期严重低氧血症的发生率，对急性低氧性呼吸衰竭患者尤其有效。然而，合适的患者选择仍然至关重要，因为某些疾病可能禁忌甚至对NIPPV有害。我们进一步讨论了如何使用这种通气支持的实际问题（最佳呼吸机设置、使用何种接口以及何时应用）。我们最后讨论了未解决的问题，并为未来探索提供建议和机会，以指导NIPPV在需要紧急气道管理的危重症患者预充氧中的作用。
