PREOXI
Trial question
What is the role of noninvasive ventilation for preoxygenation in critically ill patients undergoing tracheal intubation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 1301
1301 patients (515 female, 786 male).
Inclusion criteria: critically ill adults undergoing tracheal intubation.
Key exclusion criteria: pregnancy; incarceration; receipt of positive-pressure ventilation; apnea or hypopnea; immediate need for tracheal intubation.
Interventions
N=645 noninvasive ventilation (administration of noninvasive ventilation using a tight-fitting mask connected to either a conventional mechanical ventilator or a dedicated noninvasive ventilator).
N=656 oxygen mask (administration of supplemental oxygen using either a nonrebreather mask or bag-mask device without manual ventilation).
Primary outcome
Hypoxemia during intubation
9.1%
18.5%
18.5 %
13.9 %
9.3 %
4.6 %
0.0 %
Noninvasive
ventilation
Oxygen
mask
Significant
decrease ▼
NNT = 10
Significant decrease in hypoxemia during intubation (9.1% vs. 18.5%; ARD -9.4, 95% CI -13.2 to -5.6).
Secondary outcomes
Significant increase in median lowest oxygen saturation (99% vs. 97%; AD 2%, 95% CI 1 to 3).
Significant decrease in lowest oxygen saturation < 80% (6.2% vs. 13.2%; ARD -6.9, 95% CI -10.2 to -3.7).
No significant difference in cardiovascular collapse (17.5% vs. 19.4%; ARD -1.8, 95% CI -6.1 to 2.4).
Safety outcomes
No significant differences in aspiration, new infiltrate on chest imaging, new pneumothorax.
Conclusion
In critically ill adults undergoing tracheal intubation, noninvasive ventilation was superior to oxygen mask with respect to hypoxemia during intubation.
Reference
Kevin W Gibbs, Matthew W Semler, Brian E Driver et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024 Jun 20;390(23):2165-2177.
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