- During endotracheal intubation, bag-mask ventilation before laryngoscopy leads to better oxygen saturation and fewer desaturations, without additional adverse events.
- Number needed to treat to avoid severe hypoxemia: 9.
- Editorial: "findings provide a strong suggestion that the practice [of bag-mask ventilation after induction] is not harmful.”
Why this matters
- For patients undergoing rapid sequence intubation (RSI), ventilating during pre-laryngoscopy delay is debated, with concerns about hypoxia rivaling concerns about aspiration.
- Bag-mask vs no-ventilation groups:
- Lowest O2 saturation: 96% (interquartile range [IQR], 87%-99%) vs 93% (IQR, 81%-99%); P=.01.
- Severe hypoxemia (saturation
- Similar rates of aspiration, new opacity on chest x-ray.
- Randomized multicenter unblinded pragmatic PreVent (n=401).
- Critically ill ICU adults undergoing tracheal intubation and induction were randomly assigned to:
- Ventilation with bag-mask device, or
- No ventilation between induction and laryngoscopy.
- Outcome: lowest oxygen saturation between induction and 2 minutes after intubation.
- Funding: NIH.
- Patients with high aspiration risk excluded.
- Unknown if results generalize to emergency departments, prehospital setting.
- Underpowered to assess aspiration risk.
- Bag-mask group received more bag-mask ventilation during induction, potentially increasing oxygen reserve.
- Not designed to assess patient-centered outcomes.