New Engl J Med

What’s the optimal strategy for hypoxemia prevention during emergency intubation?

June 17, 2024

Among critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation resulted in a lower incidence of hypoxemia during intubation than preoxygenation with an oxygen mask.

• In the PREOXI trial conducted at 24 emergency departments and ICUs in the U.S., researchers randomly assigned critically ill adults undergoing tracheal intubation to receive preoxygenation with either noninvasive ventilation or an oxygen mask. Primary outcome was hypoxemia during intubation, defined by an oxygen saturation of <85% during the interval between induction of anesthesia and 2 minutes after tracheal intubation.
• Among 1,301 patients enrolled, hypoxemia occurred in 57 of 624 patients (9.1%) in the noninvasive-ventilation group vs. 118 of 637 patients (18.5%) in the oxygen-mask group (P<0.001).
• Cardiac arrest occurred in 1 patient (0.2%) in the noninvasive-ventilation group and in 7 patients (1.1%) in the oxygen-mask group (difference, -0.9 percentage points; 95% CI, -1.8 to -0.1), a nonsignificant difference. Aspiration occurred in 6 patients (0.9%) in the noninvasive-ventilation group and in 9 patients (1.4%) in the oxygen-mask group (difference, -0.4 percentage points; 95% CI, -1.6 to 0.7), a nonsignificant difference.

Source:

Gibbs KW, et al. (2024, June 13). N Engl J Med. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. https://pubmed.ncbi.nlm.nih.gov/38869091/