• Aurélien Frérou, Adel Maamar, Sonia Rafi, Claire Lhommet, Pierre Phelouzat, Emmanuel Pontis, Florian Reizine, Mathieu Lesouhaitier, Christophe Camus, Le TulzoYvesYService de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.Faculté de Médecine, Université de Rennes 1, Rennes, France., Jean-Marc Tadié, and Arnaud Gacouin.
• Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France aurelien.frerou@gmail.com.
• Respir Care. 2021 Jun 1; 66 (6): 100410151004-1015.

BackgroundThe risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ([Formula: see text]) throughout intubation in subjects in the ICU who received standard oxygen therapy, high-flow nasal cannula oxygen therapy, or noninvasive ventilation for preoxygenation. We hypothesized that the 3 methods differ in terms of ventilation and CO2 removal.MethodsIn this single-center, prospective, observational study, we recorded [Formula: see text] from preoxygenation to 3 h after the initiation of mechanical ventilation among subjects requiring endotracheal intubation. Subjects were sorted into 3 groups according to the preoxygenation method. We then assessed the link between [Formula: see text] variability and the development of postintubation hypotension.ResultsA total of 202 subjects were included in the study. The [Formula: see text] values recorded at endotracheal intubation, at the initiation of mechanical ventilation, and after 30 min and 1 h of mechanical ventilation were significantly higher than those recorded during preoxygenation (P < .05). [Formula: see text] variability differed significantly according to the preoxygenation method (P < .001, linear mixed model). A decrease in [Formula: see text] by > 5 mm Hg within 30 min after the start of mechanical ventilation was independently associated with postintubation hypotension (odds ratio = 2.14 [95% CI 1.03-4.44], P = .039) after adjustments for age, Simplified Acute Physiology Score II, COPD, cardiac comorbidity, the use of propofol for anesthetic induction, and minute ventilation at the start of mechanical ventilation.Conclusions[Formula: see text] variability during intubation is significant and differs with the method of preoxygenation. A decrease in [Formula: see text] after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.).Copyright © 2021 by Daedalus Enterprises.

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