Apnoeic oxygenation during intubation: a systematic review and meta-analysis

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Respiratory Medicine

Background:

• Apnoeic oxygenation is a technique used to maintain oxygenation during intubation.
• Preventing desaturation during intubation is crucial for patient safety.

Purpose of the Study:

• To systematically review and meta-analyze evidence on the efficacy of apnoeic oxygenation in preventing hypoxemia during endotracheal intubation.
• To assess the impact of apnoeic oxygenation on oxygen saturation (SpO2) levels during intubation procedures.

Main Methods:

• A systematic search of five major databases was conducted for studies published up to May 2016.
• Included studies featured a control group and a group receiving apnoeic oxygenation, with assessments for evidence level and risk of bias.
• Data from eleven selected studies were analyzed using meta-analysis.

Main Results:

• Meta-analysis revealed strong evidence that apnoeic oxygenation improves SpO2 in elective surgical patients, obese patients, and those undergoing emergency intubation without respiratory failure.
• No significant benefit in SpO2 was observed in patients with respiratory failure requiring intubation.
• This represents the first meta-analysis specifically examining apnoeic oxygenation during intubation.

Conclusions:

• Apnoeic oxygenation demonstrates significant benefits in improving SpO2 for the majority of intubation scenarios.
• The technique appears to provide no advantage for patients whose indication for intubation is respiratory failure.
• Integration of apnoeic oxygenation into standard intubation protocols is recommended for most patient populations.