Non-invasive ventilation for preoxygenation before general anesthesia: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background and objectives Preoxygenation is crucial for providing sufficient oxygen reservoir to a patient before intubation and enables the extension of the period between breathing termination and critical desaturation (safe apnoea time). Conventionally, face mask ventilation is used for preoxygenation. Non-invasive ventilation is a new preoxygenation method. The study objective was to compare the outcomes of non-invasive ventilation and face mask ventilation for preoxygenation. Method PubMed, Embase, Cochrane Library, and the ClinicalTrials.gov registry were searched for eligible studies published from database inception to September 2021. Individual effect sizes were standardized, and a meta-analysis was conducted using random effects models to calculate the pooled effect size. Inclusion criteria were randomised controlled trials of comparing the outcomes of non-invasive ventilation or face mask ventilation for preoxygenation in patients scheduled for surgeries. The primary outcome was safe apnea time, and the secondary outcomes were post-operative complications, number of patients who achieved the expired O2 fraction (FeO2) after 3 min of preoxygenation, minimal SpO2 during tracheal intubation, partial pressure of oxygen in the arterial blood (PaO2) and partial pressure of carbon dioxide (PaCO2) after preoxygenation, and PaO2 and PaCO2 after tracheal intubation. Results 13 trials were eligible for inclusion in this study. Significant differences were observed in safe apnoea time, number of patients who achieved FeO2 90% after preoxygenation for 3 min, and PaO2 and PaCO2 after preoxygenation and tracheal intubation. Only in the non-obese subgroup, no significant difference was observed in safe apnoea time (mean difference: 125.38, 95% confidence interval: − 12.26 to 263.03). Conclusion Non-invasive ventilation appeared to be more effective than conventional methods for preoxygenation. We recommend non-invasive ventilation based on our results.

Pressure‐controlled versus manual facemask ventilation for anaesthetic induction in adults: A randomised controlled non‐inferiority trial

“…Using CPAP or NIV during pre‐oxygenation and induction of anaesthesia will be more advantageous for certain patients, especially for obese patients, 20 and in patients with acute hypoxemic respiratory failure 21 . The benefits of PEEP in the context of protective intraoperative ventilation have a strong evidence base, 22 but the level of PEEP must not cause an increase in driving pressure 23 …”

Preoxygenation in pregnant women—is it time to update the 2015 OAA/DAS guidance in light of the expanding evidence base for high flow nasal oxygen?

“…The use of NIV to preoxygenate pregnant women has not yet been studied, but extrapolation from obese and ICU patients may provide useful insights. NIV is superior to facemask preoxygenation in both obese and hypoxic intensive care patients, but increases the risk of gastric distension and patient discomfort (20,21). However a small study in nonobstetric patients found no gastric insufflation using NIV with peak inspiratory pressures (PIP) of <20 cmH 2 O (22).…”

A Panoramic View of Airway Management in Emergency Medicine

“…For agitated patients, consider sedation or induction agents. During laryngoscopy, high-flow oxygen maintains airflow from the pharynx to the lungs [18].…”