Procedures · Preoxygenation before intubation
Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Bag-mask ventilation between induction and laryngoscopy |
| Control | No ventilation between induction and laryngoscopy |
| Population | 401 critically ill adults undergoing tracheal intubation |
| Follow-up | Intubation episode |
| Primary endpoint | Lowest oxygen saturation between induction and two minutes after intubation |
| Result | Median lowest oxygen saturation was 96% (IQR 87 to 99) with bag-mask ventilation versus 93% (IQR 81 to 99) without. Severe hypoxaemia was less frequent with bag-mask ventilation. |
| Secondary endpoints | Severe hypoxaemia, operator-reported aspiration, new opacity on chest radiograph |
Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation.
The trial authors, in the published abstract
Overturned the rapid-sequence dogma that any positive pressure before the tube risks aspiration. In critically ill patients, who desaturate in seconds rather than minutes, the calculus is simply different from elective anaesthesia.
Casey JD, Janz DR, Russell DW, et al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. N Engl J Med 2019 Feb 28;380(9):811-821.