• Vincenzo Russotto, Andrea Cortegiani, Santi Maurizio Raineri, Cesare Gregoretti, and Antonino Giarratano.
• Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del vespro 129, 90127 Palermo, Italy. Electronic address: vinrussotto@gmail.com.
• J Crit Care. 2017 Oct 1; 41: 98-106.

PurposeTo evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation.MethodsWe searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control.ResultsApneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients). Three of these studies investigated high-flow nasal cannula (HFNC) for ApOx while standard nasal cannula was used in one. Globally, ApOx was associated with higher minimum SpO2 value compared to those receiving ETI without ApOx (mean difference 2.31%, 95% CI 0.42 to 4.20, p=0.02, I2=0%) but there were not significant differences between groups in severe hypoxemia and intubation related - complications. Concerning other techniques, noninvasive ventilation (NIV) was compared to bag-valve mask in only one RCT and it reduced the degree of desaturation.ConclusionsApOx was significantly associated with higher minimum SpO2 registered during the intubation procedure. Further studies are needed to increase the number of included patients and demonstrate the benefit of ApOx and of other respiratory support methods (e.g. NIV, HFNC).Copyright © 2017 Elsevier Inc. All rights reserved.

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