Preintubation Machine-Delivered Pressure Support Ventilation With Positive End-Expiratory Pressure Versus Manual Bag-Mask Ventilation for Oxygenation in Overweight and Obese Patients: A Randomized, Pilot Study

Pragadeshwaran Rajendran; Habib Md R Karim; Chinmaya K Panda; Praveen K Neema; Samarjit Dey

doi:10.7759/cureus.45185

Preintubation Machine-Delivered Pressure Support Ventilation With Positive End-Expiratory Pressure Versus Manual Bag-Mask Ventilation for Oxygenation in Overweight and Obese Patients: A Randomized, Pilot Study

Cureus. 2023 Sep 13;15(9):e45185. doi: 10.7759/cureus.45185. eCollection 2023 Sep.

Authors

Pragadeshwaran Rajendran¹, Habib Md R Karim², Chinmaya K Panda³, Praveen K Neema⁴, Samarjit Dey⁵

Affiliations

¹ Liver Transplant Anaesthesia and Critical Care, Gleneagles Global Health City, Chennai, IND.
² Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND.
³ Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND.
⁴ Cardiac Anaesthesiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND.
⁵ Anaesthesiology, All India Institute of Medical Sciences, Mangalagiri, Mangalagiri, IND.

Abstract

Background: Noninvasive positive pressure ventilation (NIPPV) maintains mean airway pressures well, and its usability for preoxygenation is well described. Anesthesia machine-delivered NIPPV-based preoxygenation has recently been evaluated against the traditional manual bag-mask ventilation (BMV). The efficiency of such a technique over the traditional one is yet to be established well. The present study evaluated the feasibility of machine-delivered preoxygenation using pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP) and compared the effectiveness with BMV.

Methods: Thirty overweight and obese adults belonging to the American Society of Anesthesiologist's physical status I-II were randomized to receive PSV+PEEP or BMV for preintubation preoxygenation targeted to a fraction of expired oxygen (FeO₂)of 85% and 90% or for a maximum period of five minutes, whichever came first. Postintubation, the patient was observed for the time taken until 1% desaturation without ventilation. Arterial blood gases, respiratory variables, FeO₂ achieved, and different times were collected and compared.

Results: The baseline characteristics and arterial blood gases were similar between the two groups. The PSV+PEEP group had consistent and favorable tidal volume and airway pressure delivery. The difference in time to reach a FeO₂ of 85% between the two groups was not statistically different. Only two patients achieved a FeO₂ of 90% in the PSV+PEEP group versus none in the BMV group. However, partial pressure of oxygen at 1% desaturation (217.42±109.47 versus 138.073±71.319 mmHg, p 0.0259) was higher in the PSV+PEEP group. Similarly, the time until 1% desaturation was significantly prolonged in the PSV+PEEP group (206.6±76.952 versus 140.466±54.245 seconds, p 0.0111).

Conclusion: The present pilot study findings indicate that preintubation machine-delivered PSV+PEEP-based preoxygenation is feasible and might be more effective than traditional BMV in overweight and obese patients.

Keywords: airway resistance; body weight; obese; overweight; oxygen; positive pressure respiration; tidal volume; tracheal intubation.

Grants and funding

The study was conducted using the infrastructure and manpower of All India Institute of Medical Sciences, Raipur, India. Arterial blood gas analysis-related consumables and cost were also made free by the institute. No other funding from any sources was used