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Noninvasive Ventilation for Preoxygenation during Emergency Intubation.
Gibbs, Kevin W; Semler, Matthew W; Driver, Brian E; Seitz, Kevin P; Stempek, Susan B; Taylor, Caleb; Resnick-Ault, Daniel; White, Heath D; Gandotra, Sheetal; Doerschug, Kevin C; Mohamed, Amira; Prekker, Matthew E; Khan, Akram; Gaillard, John P; Andrea, Luke; Aggarwal, Neil R; Brainard, Jason C; Barnett, LuAnn H; Halliday, Stephen J; Blinder, Veronika; Dagan, Alon; Whitson, Micah R; Schauer, Steven G; Walker, James E; Barker, Andrew B; Palakshappa, Jessica A; Muhs, Amelia; Wozniak, Joanne M; Kramer, Patrick J; Withers, Cori; Ghamande, Shekhar A; Russell, Derek W; Schwartz, Andrei; Moskowitz, Ari; Hansen, Sydney J; Allada, Gopal; Goranson, Jordan K; Fein, Daniel G; Sottile, Peter D; Kelly, Nicholas; Alwood, Shannon M; Long, Micah T; Malhotra, Rishi; Shapiro, Nathan I; Page, David B; Long, Brit J; Thomas, Christopher B; Trent, Stacy A; Janz, David R; Rice, Todd W.
Afiliação
  • Gibbs KW; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Semler MW; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Driver BE; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Seitz KP; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Stempek SB; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Taylor C; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Resnick-Ault D; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • White HD; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Gandotra S; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Doerschug KC; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Mohamed A; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Prekker ME; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Khan A; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Gaillard JP; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Andrea L; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Aggarwal NR; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Brainard JC; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Barnett LH; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Halliday SJ; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Blinder V; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Dagan A; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Whitson MR; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Schauer SG; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Walker JE; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Barker AB; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Palakshappa JA; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Muhs A; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Wozniak JM; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Kramer PJ; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Withers C; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Ghamande SA; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Russell DW; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Schwartz A; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Moskowitz A; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Hansen SJ; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Allada G; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Goranson JK; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Fein DG; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Sottile PD; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Kelly N; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Alwood SM; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Long MT; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Malhotra R; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Shapiro NI; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Page DB; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Long BJ; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Thomas CB; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Trent SA; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Janz DR; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
  • Rice TW; From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, W
N Engl J Med ; 390(23): 2165-2177, 2024 Jun 20.
Article em En | MEDLINE | ID: mdl-38869091
ABSTRACT

BACKGROUND:

Among critically ill adults undergoing tracheal intubation, hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain.

METHODS:

In a multicenter, randomized trial conducted at 24 emergency departments and intensive care units in the United States, we randomly assigned critically ill adults (age, ≥18 years) undergoing tracheal intubation to receive preoxygenation with either noninvasive ventilation or an oxygen mask. The primary outcome was hypoxemia during intubation, defined by an oxygen saturation of less than 85% during the interval between induction of anesthesia and 2 minutes after tracheal intubation.

RESULTS:

Among the 1301 patients enrolled, hypoxemia occurred in 57 of 624 patients (9.1%) in the noninvasive-ventilation group and in 118 of 637 patients (18.5%) in the oxygen-mask group (difference, -9.4 percentage points; 95% confidence interval [CI], -13.2 to -5.6; P<0.001). Cardiac arrest occurred in 1 patient (0.2%) in the noninvasive-ventilation group and in 7 patients (1.1%) in the oxygen-mask group (difference, -0.9 percentage points; 95% CI, -1.8 to -0.1). Aspiration occurred in 6 patients (0.9%) in the noninvasive-ventilation group and in 9 patients (1.4%) in the oxygen-mask group (difference, -0.4 percentage points; 95% CI, -1.6 to 0.7).

CONCLUSIONS:

Among critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation resulted in a lower incidence of hypoxemia during intubation than preoxygenation with an oxygen mask. (Funded by the U.S. Department of Defense; PREOXI ClinicalTrials.gov number, NCT05267652.).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Oxigenoterapia / Ventilação não Invasiva / Intubação Intratraqueal / Hipóxia Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: N Engl J Med Ano de publicação: 2024 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Oxigenoterapia / Ventilação não Invasiva / Intubação Intratraqueal / Hipóxia Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: N Engl J Med Ano de publicação: 2024 Tipo de documento: Article