Intubation using apnoeic oxygenation to prevent desaturation: A systematic review and meta-analysis

Authors

Rhys S. Holyoak, University of WollongongFollow
Thomas M. Melhuish, University of New South Wales, Wagga Wagga Rural Referral Hospital
Ruan Vlok, University of Notre Dame, Wagga Wagga Rural Referral Hospital
M Binks, University of New South Wales, Wagga Wagga Rural Referral Hospital
Leigh D. White, University of Wollongong, Wagga Wagga Rural Referral HospitalFollow

RIS ID

114940

Publication Details

Holyoak, R. S., Melhuish, T. M., Vlok, R., Binks, M. & White, L. D. (2017). Intubation using apnoeic oxygenation to prevent desaturation: A systematic review and meta-analysis. Journal of Critical Care, 41 42-48.

Abstract

Purpose To determine whether or not apnoeic oxygenation reduces the incidence of hypoxaemia during endotracheal intubation. Materials and methods A systematic search of six databases for all relevant studies until November 2016 was performed. All study designs using apnoeic oxygenation during intubation were eligible for inclusion. All studies were assessed for level of evidence and risk of bias. A meta-analysis was performed on all data using Revman 5.3. Results Seventeen studies including 2422 patients were retrieved. Overall there was a significant reduction in the incidence of desaturation (RR = 0.65; p < 0.00001), critical desaturation (RR = 0.61, p = 0.002) and safe apnoea time (WMD = 1.73 min, p < 0.00001). There was no significant difference in mortality (RR = 0.77, p = 0.08). Conclusions In patients whom are being intubated for any indication other than respiratory failure, apnoeic oxygenation at any flow rate 15 L or greater is likely to reduce their incidence of desaturation (< 90%) and critical desaturation (< 80%). However, further high quality RCTs are required given the high degree of heterogeneity in many of the outcomes and subgroup analyses.