Casey JD, et al. - Investigators assessed 401 adults undergoing tracheal intubation to see if hypoxemia could be prevented via positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults without raising the risk of aspiration. Among critically ill patients, they observed higher oxygen saturation and a reduced incidence of severe hypoxemia via bag-mask ventilation as well as a lower incidence of severe hypoxemia vs those who had no ventilation.

Methods

• In this multicenter, randomized trial conducted in seven intensive care units in the US, they assigned individuals undergoing tracheal intubation randomly to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy.
• Lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation was the primary outcome; incidence of severe hypoxemia (oxygen saturation of less than 80%) was the secondary outcome.

Results

• Among 401 candidates involved, they observed median lowest oxygen saturation of 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P=0.01).
• They noticed severe hypoxemia among 21 candidates (10.9%) in the bag-mask ventilation group vs 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77).
• During 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P=0.41) operator-reported aspiration occurred.
• They found the incidence of new opacity on chest radiography in the 48 hours after tracheal intubation, 16.4% and 14.8%, respectively (P=0.73).