In critically ill adults undergoing emergency tracheal intubation, hypoxemia (low levels of oxygen in the blood) increases the risk of cardiac arrest and death. In current clinical care, most critically ill adults receive preoxygenation using an oxygen mask. Preoxygenation is the administration of supplemental oxygen before the start of a procedure to increase the content of oxygen in the lung and decrease the risk of hypoxemia during the tracheal intubation procedure.
Wake Forest University School of Medicine was part of the Department of the Defense-funded Pragmatic Trial Examining Oxygenation Prior to Intubation (PREOXI) trial comparing the two most commonly used methods used to preoxygenate patients prior to tracheal intubation: preoxygenation with noninvasive ventilation and preoxygenation with an oxygen mask. The study showed that the noninvasive ventilation method (a way to support breathing by using a tight-fitting respiratory mask connected to a BPAP - bilevel positive airway pressure - machine) reduced the risks associated with the intubation procedure.
The findings appear online today in the New England Journal of Medicine.
“We compared two methods used to preoxygenate patients before tracheal intubation - preoxygenation with noninvasive ventilation and preoxygenation with an oxygen mask,” said Kevin Gibbs, M.D., associate professor of pulmonary, critical care, allergy and immunologic diseases at Wake Forest University School of Medicine and the paper’s corresponding author. “We found that the noninvasive ventilation method decreases the incidence of hypoxemia compared to preoxygenation with an oxygen mask.”
The multicenter, randomized trial was conducted in 24 emergency departments and intensive care units in the United States. Critically ill adults undergoing tracheal intubation were randomly assigned to two groups: preoxygenation using noninvasive ventilation or preoxygenation using an oxygen mask.
In the 1,301 patients enrolled, hypoxemia occurred in 57 of the 624 patients (9.1%) in the noninvasive ventilation group and 118 of the 637 patients (18.5%) in the oxygen mask group. Further, it appeared that by preventing hypoxemia during tracheal intubation, preoxygenation with non-invasive ventilation also prevented cardiac arrest, the most feared complication of tracheal intubation, which occurred in one patient (0.2%) in the noninvasive ventilation group and seven patients (1.1%) in the oxygen mask group.
“Applying these results to clinical care by routinely using noninvasive ventilation for preoxygenation before tracheal intubation has the potential to prevent tens of thousands of patients each year from experiencing hypoxemia and cardiac arrest,” Gibbs said.
The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the U.S. Government.
Read the full release from Vanderbilt University Medical Center.
Media contact: Myra Wright, mgwright@wakehealth.edu