Clinical Question

Should we be using NIV to preoxygenate our patients for RSI?

Title of Paper

Noninvasive Ventilation for Preoxygenation during Emergency Intubation

Journal and Year

NEJM. 2024

Lead Author

Gibbs

Background

• Pre-oxygenating patients via NIV (BiPAP) became a bit more common, at least in Australia, during COVID as a safer means of pre-oxygenating out patients who all had very impressive hypoxemic respiratory failure.
• It’s a bit fiddly, annoying, and resource intensive to get it set up just for preoxygenation and carries a risk of aspiration, particularly once you obtund a patient with induction drugs
• Apparently some people are still using face masks such as a NRB to pre-oxygenate their patients for RSI. International guidelines apparently say either method is ok.
• The authors suspected hypoxemia would be less common in patients preoxygenated with NIV.

Study Design

• Multicentre, RCT
• 24 EDs and ICUs in the USA

Patients Studied

• Adults undergoing emergency intubation
• Exclusions included those already having positive pressure ventation (NIV) or if provider felt either NIV or O2 were necessary or contraindicated.

Intervention