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GENERAL ARTICLE

The Effectiveness of Noninvasive Positive Pressure Ventilation to Enhance Preoxygenation in Morbidly Obese Patients: A Randomized Controlled Study

Jean-Marc Delay, MD^*, Mustapha Sebbane, MD^*, Boris Jung, MD^*, David Nocca, MD, Daniel Verzilli, MD^*, Yvan Pouzeratte, MD^*, Moez El Kamel, MD^*, Jean-Michel Fabre, MD, PhD, Jean-Jacques Eledjam, MD, PhD^*, and Samir Jaber, MD, PhD^*

From the Departments of *Anesthesia and Critical Care B (DAR B), and Digestive Surgery, Saint-Eloi University Hospital of Montpellier, Montpellier, France.

Address correspondence and reprint requests to Samir Jaber, MD, PhD, Department of Anesthesia and Critical Care B (DAR B), Hôpital Saint Eloi, 80, avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. Address e-mail to s-jaber{at}chu-montpellier.fr.

BACKGROUND: Noninvasive positive-pressure ventilation (NPPV) with pressure support-ventilation and positive end-expiratory pressure are effective in providing oxygenation during intubation in hypoxemic patients. We hypothesized administration of oxygen (O₂) using NPPV would more rapidly increase the end-tidal O₂ concentration (ETo₂) than preoxygenation using spontaneous ventilation (SV) in morbidly obese patients.

METHODS: Twenty-eight morbidly obese patients were enrolled in this prospective randomized study. Administration of O₂ for 5 min was performed either with SV group or with NPPV (pressure support = 8 cm H₂O, positive end-expiratory pressure = 6 cm H₂O) (NPPV group). ETo₂ was measured using the anesthesia breathing circuit, and is expressed as a fraction of atmospheric concentration. The primary end-point was the number of patients with an ETo₂ >95% at the end of O₂ administration. Secondary end-points included the time to reach the maximal ETo₂ and the ETo₂ at the conclusion of O₂ administration.

RESULTS: A larger proportion of patients achieved a 95% ETo₂ at 5 min with NPPV than SV (13/14 vs 7/14, P = 0.01). The time to reach the maximal ETo₂ was significantly less in the NPPV than in the SV group (185 ± 46 vs 222 ± 42 s, P = 0.02). The mean ETo₂ at the conclusion of O₂ administration was larger in the NPPV group than the SV group (96.9 ± 1.3 vs 94.1 ± 2.0%, P < 0.001). A modest, although significant, increase in gastric distension was observed in the NPPV group. No adverse effects were observed in either group.

CONCLUSION: Administration of O₂ via a facemask with NPPV in the operating room is safe, feasible, and efficient in morbidly obese patients. In this population NPPV provides a more rapid O₂ administration, achieving a higher ETo₂.

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				Preoxygenation with NPPV in Obese Adults Journal Watch Emergency Medicine, December 12, 2008; 2008(1212): 5 - 5. [Full Text]