Background
Methods
Study population
Non-invasive ventilation procedure
High-flow nasal cannula oxygen therapy
Preoxygenation
Cohorts
Simplified acute physiology score II
Modified Cormack-Lehane grade
Intubation difficulty scale score
MACOCHA score
Hypoxemia
Laryngoscopy
Complications
Statistical analysis
Results
Study population
Demographical and clinical conditions
Parameters | Cohorts | Comparisons between cohorts | |
---|---|---|---|
NIV | HCO | ||
Procedure for oxygenation and ventilation | Non-invasive ventilation | High-flow nasal cannula oxygen | |
Patients included in the analysis | 154 | 161 | p-value |
Age (years) | |||
Minimum | 28 | 27 | 0.377 |
Maximum | 68 | 67 | |
Mean ± SD | 57.12 ± 11.14 | 58.22 ± 10.91 | |
Sex | |||
Male | 105 (68) | 107 (66) | 0.811 |
Female | 49 (32) | 54 (34) | |
Body-mass index (kg/m2) | 25.52 ± 1.11 | 25.22 ± 1.85 | 0.084 |
Simplified Acute Physiology Score II | 53 ± 13 | 50 ± 15 | 0.059 |
Sepsis-related Organ Failure Assessment score | 8.12 ± 4.35 | 9.01 ± 4.61 | 0.079 |
Underlying chronic lung disease | 42 (27) | 51 (32) | 0.459 |
Upper airway tract cancer history | 6 (4) | 4 (2) | 0.531 |
Reason for the intensive care unit admission | |||
Respiratory infection | 54 (35) | 61 (38) | 0.392 |
Chronic obstructive pulmonary disease exacerbation | 10 (7) | 11 (7) | |
Extra-pulmonary acute respiratory distress syndrome. | 15 (10) | 12 (7) | |
Pulmonary atelectasis | 5 (3) | 3 (2) | |
Shock | 42 (27) | 57 (35) | |
Cardiogenic pulmonary edema | 15 (10) | 8 (5) | |
Neurologic conditions | 13 (8) | 9 (6) | |
Vasopressor support at inclusion | 28 (18) | 31 (19) | 0.885 |
Bilateral pulmonary infiltrates | 77 (50) | 82 (51) | 0.911 |
Respiratory rates (breaths/ min) | 61 ± 9 | 62 ± 8 | 0.298 |
The partial pressure of arterial oxygen to fraction of inspired oxygen ratio | |||
Mild hypoxemia (201–300 mmHg) | 34 (22) | 35 (22) | 0.889 |
Moderate-to-severe hypoxemia (≤200 mmHg) | 120 (78) | 126 (78) |
Hypoxia
Values of pulse oximetry | Cohorts | Comparisons between cohorts | |
---|---|---|---|
NIV | HCO | ||
Procedure for oxygenation and ventilation | Non-invasive ventilation | High-flow nasal cannula oxygen | |
Patients included in the analysis | 154 | 161 | p-value |
Hypoxemia | |||
At the beginning of preoxygenation (mean ± standard deviation) | 95 ± 4% | 94 ± 5% | 0.052 |
The lowest value during the intubation procedure (mean ± standard deviation) | 78 ± 4% | 77 ± 6% | 0.084 |
Numbers of patients with severe hypoxiaa (frequency (percentages)) | 35 (23) | 45 (28) | 0.303 |
At the end of preoxygenation (mean ± standard deviation) | 97 ± 5% | 96 ± 5% | 0.077 |
Values of pulse oximetry | Mild hypoxemia (201–300 mmHg)b | ap-value | Moderate-to-severe hypoxemia (≤200 mmHg)b | ap-value | ||
---|---|---|---|---|---|---|
NIV cohort | HCO cohort | NIV cohort | HCO cohort | |||
Procedure for oxygenation and ventilation | Non-invasive ventilation | High-flow nasal cannula oxygen | Non-invasive ventilation | High-flow nasal cannula oxygen | ||
Patients included in the analysis | 34 | 35 | 120 | 126 | ||
At the beginning of preoxygenation | 96 ± 2% | 95 ± 3% | 0.109 | 94 ± 5% | 93 ± 5% | 0.118 |
The lowest value during the intubation procedure | 79 ± 3% | 78 ± 2% | 0.107 | 77 ± 15% | 76 ± 12% | 0.084 |
At the end of preoxygenation | 98 ± 5% | 95 ± 8% | 0.067 | 96 ± 8% | 94 ± 8% | 0.052 |
Laryngoscopy
Parameters | Cohorts | Comparisons between cohorts | |
---|---|---|---|
NIV | HCO | ||
Procedure for oxygenation and ventilation | Non-invasive ventilation | High-flow nasal cannula oxygen | |
Patients included in the analysis | 154 | 161 | p-value |
Time duration of laryngoscopy (min) | |||
< 1 | 87 (56) | 96 (59) | 0.847 |
1–3 | 52 (34) | 51 (32) | |
> 3 | 15 (10) | 14 (9) | |
Number of laryngoscopies attempts | |||
1 | 123 (80) | 126 (78) | 0.804 |
2 | 23 (15) | 28 (18) | |
≥ 3 or procedural time ≥ 10 min | 8 (5) | 7 (4) |
Intubation scoring items
Scoring items | Cohorts | Comparisons between cohorts | |
---|---|---|---|
NIV | HCO | ||
Procedure for oxygenation and ventilation | Non-invasive ventilation | High-flow nasal cannula oxygen | |
Patients included in the analysis | 154 | 161 | p-value |
MACOCHA score | |||
< 3 | 123 (80) | 134 (83) | 0.469 |
≥ 3 | 31 (20) | 27 (17) | |
Modified Cormack-Lehane grade | |||
I, IIA, or IIB | 139 (90) | 144 (89) | 0.854 |
III or IV | 15 (10) | 17 (11) | |
Intubation Difficulty Scale score | |||
0–2 | 15 (10) | 14 (9) | 0.733 |
3–4 | 87 (57) | 98 (61) | |
≥ 5 | 52 (34) | 49 (30) |
Immediate and late complications
Complications | Cohorts | Comparisons between cohorts | |
---|---|---|---|
NIV | HCO | ||
Procedure for oxygenation and ventilation | Non-invasive ventilation | High-flow nasal cannula oxygen | |
Patients included in the analysis | 154 | 161 | p-value |
Use of alternative management devices | 17 (11) | 23 (14) | 0.403 |
Agitation | 2 (1) | 1 (1) | 0.616 |
At least one episode of systolic arterial hypotension < 90 mmHg | 71 (46) | 83 (52) | 0.368 |
Bradycardia | 3 (2) | 5 (3) | 0.724 |
Sustained arrhythmia | 4 (3) | 3 (2) | 0.718 |
Esophageal intubation | 9 (6) | 8 (5) | 0.806 |
Regurgitation | 1 (1) | 2 (1) | 0.998 |
Gastric distension | 12 (8) | 11 (7) | 0.829 |
Injuries in the oral cavity | 1 (1) | 2 (1) | 0.998 |
New infiltrate on chest radiograph | 29 (19) | 33 (20) | 0.777 |
Cardiac arrest | 2 (1) | 8 (5) | 0.105 |
Complications | Cohorts | Comparisons between cohorts | |
---|---|---|---|
NIV | HCO | ||
Procedure for oxygenation and ventilation | Non-invasive ventilation | High-flow nasal cannula oxygen | |
Patients included in the analysis | 154 | 161 | p-value |
Sepsis-related Organ Failure Assessment score at 1 | 9.89 ± 2.52 | 10.45 ± 3.52 | 0.107 |
Sepsis-related Organ Failure Assessment score at 7 | 6.12 ± 1.22 | 6.62 ± 3.15 | 0.066 |
Ventilator-associated pneumonia | 38 (25) | 32 (20) | 0.344 |
Duration of mechanical ventilation (days) | 11.12 ± 3.45 | 11.78 ± 3.11 | 0.075 |
Length of stay in the intensive care unit (days) | 14.11 ± 3.16 | 14.22 ± 4.12 | 0.791 |
Death within a month | 43 (28) | 51 (32) | 0.538 |