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SYSTEMATIC REVIEW article

Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1532911
This article is part of the Research Topic Advancements in Mechanical Ventilation: Understanding Physiology to Mitigate Complications View all 3 articles

Pre-oxygenation strategies before intubation in patients with acute hypoxic respiratory failure: a network meta-analysis

Provisionally accepted
Na Ye Na Ye 1*Chen Wei Chen Wei 2Jiaxiang Deng Jiaxiang Deng 2*Yingying Wang Yingying Wang 2*Hongwen Xie Hongwen Xie 1*
  • 1 Fourth Affiliated Hospital of Jiangsu University, zhenjiang, China
  • 2 First Affiliated Hospital of Wannan Medical College, Wuhu, China

The final, formatted version of the article will be published soon.

    Abstract Background: Patients with acute hypoxic respiratory failure face life-threatening complications during tracheal intubation. Preoxygenation can enhance oxygen reserves and mitigate hypoxemia risk, but the optimal strategy remains unclear. This study aimed to identify the best preoxygenation strategy for these patients.Methods: We conducted a network meta-analysis of studies published up to July 2024, evaluating conventional oxygen therapy (COT), high flow nasal cannula (HFNC), noninvasive ventilation (NIV), and their combinations prior to intubation. Data were extracted and analyzed using pairwise and network meta-analysis within a Bayesian framework. Model selection was based on the deviance information criterion (DIC).Results: Eleven randomized controlled trials involving 2,874 patients were included. NIV preoxygenation significantly reduced the likelihood of SpO2 <80% during intubation compared to COT (RR 0.28, 95% CI 0.070-0.71). No significant differences were found in lowest SpO2, complications, ICU length of stay, or mortality across preoxygenation strategies. HFNC was the most effective for reducing complications, while HFNC combined with COT or NIV showed similar effects on lowest SpO2 during intubation.Conclusion: Preoxygenation with HFNC appears to be the safest and most effective approach prior to intubation in patients with acute hypoxic respiratory failure compared to other strategies.

    Keywords: Acute hypoxic respiratory failure, preoxygenation, high flow nasal c annula, non-invasive ventilation, Network meta-analysis

    Received: 22 Nov 2024; Accepted: 08 Jan 2025.

    Copyright: © 2025 Ye, Wei, Deng, Wang and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Na Ye, Fourth Affiliated Hospital of Jiangsu University, zhenjiang, China
    Jiaxiang Deng, First Affiliated Hospital of Wannan Medical College, Wuhu, China
    Yingying Wang, First Affiliated Hospital of Wannan Medical College, Wuhu, China
    Hongwen Xie, Fourth Affiliated Hospital of Jiangsu University, zhenjiang, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.