Overview of Vourc'h et al.
Consideration of these results in context of physiology
Why didn't they observe a difference?
- Vourc'h et al. found that neither HFNC nor apneic oxygenation were effective for reducing desaturation during intubation. This is probably due to a high level of heterogeneity among patients, drowning any potential signal in noise.
- This study should notbe used as evidence to abandon HFNC and apneic oxygenation to reduce peri-intubation desaturation. In particular there is an extensive body of evidence supporting the efficacy of apneic oxygenation (e.g., Weingart and Levitan 2011). The precise role of HFNC remains unclear.
- Providing 100% FiO2 cannot prevent desaturation due to lung collapse. For patients at high risk of lung collapse (e.g. ARDS, morbid obesity), noninvasive ventilation should be considered since it provides both positive pressure and high FiO2.
(1) Vourc'h M et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: A randomized controlled trial. Intensive Care Med, April 2015.