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Noninvasive Ventilation for Preoxygenation during Emergency Intubation

Hypoxemia can occur in up to 20% of intubations and may lead to adverse outcomes such as peri-intubation cardiovascular collapse or cardiac arrest.
At present, the majority of critically ill patients undergoing RSI are preoxygenated with an oxygen mask.
This study compared the use of noninvasive ventilation for preoxygenation to an oxygen mask on the incidence of hypoxemia during intubation.
In over 1,300 patients, the incidence of hypoxemia during the interval between induction and 2 minutes after intubation was markedly lower in patients preoxygenated with noninvasive ventilation compared to those preoxygenation with an oxygen mask.
The greatest benefit to noninvasive ventilation for preoxygenation was seen in patients with acute hypoxemic respiratory failure, those requiring more than 70% FiO2 prior to intubation, and those with a BMI above 30.
The trial did not enroll patients who needed emergent intubation without time for at least 3 minutes of preoxygenation.

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