High-Flow Nasal Cannula Oxygen Does Not Prevent Desaturation During Intubation

Published in Intensive Care Med 2015 Apr 14

Authors: Vourc’h M et al.

In an unblinded, randomized trial of ICU patients with hypoxemic respiratory failure, high-flow nasal cannula oxygenation did not reduce desaturation during intubation.

Despite adequate preoxygenation, desaturation is common during endotracheal intubation in patients with respiratory disease. The use of high-flow nasal cannula oxygenation has recently been proposed to increase oxygen saturation during intubation, but no randomized trials have previously been published.

Investigators enrolled 124 patients at six French intensive care units who required endotracheal intubation for hypoxemic respiratory failure. Patients were at high risk for desaturation, with PaO2/FiO2 <300 mm Hg, respiratory rate ≥30 breaths per minute, and FiO2 requirement of ≥50%. Patients were preoxygenated for 4 minutes with either face-mask oxygen or high-flow nasal cannula oxygen, which delivers nearly 100% FiO2 at 60 L/minute. Those in the nasal cannula group continued to receive high-flow nasal cannula oxygen throughout the procedure. The trial was powered to detect a 6% increase in the lowest oxygen saturation values. The trial was partly funded by the maker of the nasal cannula device.

Baseline variables, the rate of difficult intubation, and the duration of the procedure were similar between the two groups. There were no statistical differences between the nasal cannula and face-mask groups in lowest oxygen saturation (median, 92% and 90%) or proportion of patients whose oxygen saturation dropped below 80% (26% and 22%). Notably, mean oxygen saturations for both groups were only 96% to 97% after preoxygenation, suggesting that complete nitrogen washout was not achieved in this cohort of very sick patients.

Comment
While the downsides of high-flow nasal cannula oxygenation would seem to be low, its use did not prevent desaturation, at least in this very high risk cohort.