Preoxygenation with noninvasive ventilation better than that with oxygen mask alone

Study by PREOXI Investigators and the Pragmatic Critical Care Research Group published in the New England Journal of Medicine compared the effects of preoxygenation with noninvasive ventilation and preoxygenation with oxygen mask, prior to intubation among critically ill persons [1]. Hypoxemia increases the risk of cardiac arrest and death among critically ill adults undergoing tracheal intubation for invasive ventilation. It was a multcentre randomized trial conducted at emergency departments and intensive care units in the United States of America in 1301 patients. Primary outcome was hypoxemia during intubation. In the trial, hypoxemia during intubation was defined as an oxygen saturation less than 85% during the interval between induction of anaesthesia and 2 minutes after tracheal intubation.

While hypoxemia occurred in 9.1% of the noninvasive ventilation group, it was noted in 18.5% of the oxygen mask group. Cardiac arrest occurred in one patient in the noninvasive ventilation group and in 7 patients in the oxygen mask group. Six patients in the noninvasive ventilation group had aspiration while it occurred in 9 of the oxygen mask group. Study authors concluded that among critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation resulted in lower incidence of hypoxemia during intubation than preoxygenation with an oxygen mask.

Reference

1. Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, Resnick-Ault D, White HD, Gandotra S, Doerschug KC, Mohamed A, Prekker ME, Khan A, Gaillard JP, Andrea L, Aggarwal NR, Brainard JC, Barnett LH, Halliday SJ, Blinder V, Dagan A, Whitson MR, Schauer SG, Walker JE Jr, Barker AB, Palakshappa JA, Muhs A, Wozniak JM, Kramer PJ, Withers C, Ghamande SA, Russell DW, Schwartz A, Moskowitz A, Hansen SJ, Allada G, Goranson JK, Fein DG, Sottile PD, Kelly N, Alwood SM, Long MT, Malhotra R, Shapiro NI, Page DB, Long BJ, Thomas CB, Trent SA, Janz DR, Rice TW, Self WH, Bebarta VS, Lloyd BD, Rhoads J, Womack K, Imhoff B, Ginde AA, Casey JD; PREOXI Investigators and the Pragmatic Critical Care Research Group. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024 Jun 20;390(23):2165-2177. doi: 10.1056/NEJMoa2313680. Epub 2024 Jun 13. PMID: 38869091.