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A Nasal Cannula Under the Noninvasive Positive Pressure Ventilation Mask?

Daniel J. Pallin, MD, MPH

 

A crossover trial in healthy volunteers suggests that a nasal cannula does not increase mask leaking significantly.

 

Research suggests that apneic oxygenation is of benefit during rapid sequence intubation (NEJM JW Emerg Med Sep 2017 and Am J Emerg Med 2017; 35:1184). Apneic oxygenation involves use of highflow oxygen via a nasal cannula during laryngoscopy. In practice, it means that patients who may require intubation are given a nasal cannula and a non-rebreather mask or noninvasive positive pressure ventilation (NPPV).

 

To evaluate whether a nasal cannula causes the NPPV mask to leak, investigators enrolled 64 healthy volunteers in a crossover study in which each participant served as his or her own control. Participants underwent 1 minute of NPPV with a nasal cannula and 1 minute of NPPV without a nasal cannula, in random order, with a 2-minute washout period between interventions. The main outcome measure was the amount of gas leaked from the mask during 1 minute, with a prespecified noninferiority margin of 5 L/minute. There was no significant increase in mask leakage when the nasal cannula was used.

 

Comment:
This provocative small study suggests that for patients with serious respiratory compromise
who require NPPV, a nasal cannula should be placed beneath the NPPV mask so that it is ready in case NPPV needs to be converted to rapid sequence intubation.

 

Citation(s):
Brown DJ et al. Face mask leak with nasal cannula during noninvasive positive pressure ventilation: A randomized crossover trial. Am J Emerg Med 2017 Dec 2; [e-pub].

(http://dx.doi.org/10.1016/j.ajem.2017.10.055)

 

Copyright © 2017. Massachusetts Medical Society. All rights reserved.