Irfan Zubair Shahul Hameed, Darpanarayan Hazra, Priya Ganesan, Abhilash Kundavaram Paul Prabhakar

Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Keywords: Apneic oxygenation, Bag‑Valve‑Mask preoxygenation, hypoxic arrest, nasopharyngeal cannula, nasopharyngeal high‑flow preoxygenation, passive preoxygenation, randomized control trial


OBJECTIVES: In the context of  acute hypoxemic respiratory failure (AHRF), ensuring effective preoxygenation and apneic oxygenation emerges as the pivotal approach ensuring for averting hypoxemic adverse events during endotracheal intubation. To investigate this, we conducted an open label randomized controlled trial, aiming to assess the comparative effectiveness of nasopharyngeal high flow oxygenation in conjunction with Bag Valve Mask (BVM) versus standard BVM preoxygenation in patients experiencing AHRF within the emergency department (ED).

METHODS: This prospective single center, open labeled, randomized controlled trial enrolled patients aged 18 years and above requiring rapid sequence intubation due to AHRF in the ED. Participants were randomly assigned in a 1:1 ratio to either the intervention arm (involving nasopharyngeal high flow oxygenation and BVM preoxygenation) or the control arm (involving BVM preoxygenation alone).

RESULTS: A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO2 at 0 min postintubation was 95.5 (80%–99%) versus 89 (76%–98%); z score: 1.081, P = 0.279 in the intervention and control arm, respectively. The most common postintubation complications included hypoxia (intervention arm: 56.7% vs. control arm: 66.7%) and circulatory/hypoxic arrest (intervention arm: 39.5% vs. control arm: 44.7%). There were no adverse complications in 36.7% (n = 11) of patients in the intervention arm. Despite the best possible medical management, almost half (52.6%) of patients in the intervention arm and 47.4% of patients in the control arm succumbed to their illnesses in the ED.

CONCLUSION: The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation related adverse effects.

How to cite this article: Shahul Hameed IZ, Hazra D, Ganesan P, Prabhakar AK. Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial. Turk J Emerg Med 2024;24(1):33-40.

Ethics Committee Approval

This study was approved by the Institutional Review Board before the commencement of the study (IRB Min no: 13670 dated 16/12/2020) Christian Medical College and Hospital, Vellore, India, and Clinical Trial Registry‑India, CTRI/ 2021/04/032993,). Patient confidentiality was maintained using unique identifiers and password‑protected data entry software with restricted users.

Author Contributions

IZ: Conceptualization. Data curation, Investigations, Methodology, Resources, Writing – original draft, Writing – review and editing
DH: Data curation, Formal analysis, Investigations, Methodology, Resources, Writing – original draft, Writing – review and editing
PG: Conceptualization, Investigations, Methodology, Project administration, supervision, Writing – review and editing
KA: Conceptualization, Formal analysis, Investigations, Methodology, Project administration, supervision, Writing – review and editing.

Conflict of Interest

None Declared.

Financial Disclosure