Open AccessBag-Mask Ventilation Versus Apneic Oxygenation During Tracheal Intubation in Critically Ill Adults: A Secondary Analysis of 2 Randomized Trials
Author(s) -
E Vaughan,
Kevin P. Seitz,
David R. Janz,
Derek W. Russell,
James Dargin,
Derek J Vonderhaar,
Aaron M. Joffe,
Jason R. West,
Wesley H. Self,
Todd W. Rice,
Matthew W. Semler,
Jonathan D. Casey
Publication year - 2021
Publication title -
journal of intensive care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 58
eISSN - 1525-1489
pISSN - 0885-0666
DOI - 10.1177/08850666211058646
Subject(s) - medicine , anesthesia , hypoxemia , nasal cannula , intubation , oxygenation , ventilation (architecture) , interquartile range , randomized controlled trial , mechanical ventilation , intensive care , randomization , oxygen saturation , cannula , surgery , oxygen , intensive care medicine , mechanical engineering , chemistry , organic chemistry , engineering
Background: Hypoxemia is common during tracheal intubation in intensive care units. To prevent hypoxemia during intubation, 2 methods of delivering oxygen between induction and laryngoscopy have been proposed: bag-mask ventilation and supplemental oxygen delivered by nasal cannula without ventilation (apneic oxygenation). Whether one of these approaches is more effective for preventing hypoxemia during intubation of critically ill patients is unknown. Methods: We performed a secondary analysis of data from 138 patients enrolled in 2, consecutive randomized trials of airway management in an academic intensive care unit. A total of 61 patients were randomized to receive bag-mask ventilation in a trial comparing bag-mask ventilation to none, and 77 patients were randomized to receive 100% oxygen at 15 L/min by nasal cannula in a trial comparing apneic oxygenation to none. Using multivariable linear regression accounting for age, body mass index, severity of illness, and oxygen saturation at induction, we compared patients assigned to bag-mask ventilation with those assigned to apneic oxygenation regarding lowest oxygen saturations from induction to 2 min after intubation. Results: Patients assigned to bag-mask ventilation and apneic oxygenation were similar at baseline. The median lowest oxygen saturation was 96% (interquartile range [IQR] 89%-100%) in the bag-mask ventilation group and 92% (IQR 84%-99%) in the apneic oxygenation group. After adjustment for prespecified confounders, bag-mask ventilation was associated with a higher lowest oxygen saturation compared to apneic oxygenation (mean difference, 4.2%; 95% confidence interval, 0.7%-7.8%; P = .02). The incidence of severe hypoxemia (oxygen saturation<80%) was 6.6% in the bag-mask ventilation group and 15.6% in the apneic oxygenation group (adjusted odds ratio, 0.33; P = .09). Conclusions: This secondary analysis of patients assigned to bag-mask ventilation and apneic oxygenation during 2 clinical trials suggests that bag-mask ventilation is associated with higher oxygen saturation during intubation compared to apneic oxygenation.