Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
28 02 2019
28 02 2019
Historique:
pubmed:
20
2
2019
medline:
8
3
2019
entrez:
20
2
2019
Statut:
ppublish
Résumé
Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial. In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%. Among the 401 patients enrolled, the median lowest oxygen saturation was 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). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P = 0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P = 0.73). Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. (Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.).
Sections du résumé
BACKGROUND
Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial.
METHODS
In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%.
RESULTS
Among the 401 patients enrolled, the median lowest oxygen saturation was 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). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P = 0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P = 0.73).
CONCLUSIONS
Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. (Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.).
Identifiants
pubmed: 30779528
doi: 10.1056/NEJMoa1812405
pmc: PMC6423976
mid: NIHMS1523729
doi:
Substances chimiques
Oxygen
S88TT14065
Banques de données
ClinicalTrials.gov
['NCT03026322']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
811-821Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000445
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL143053
Pays : United States
Organisme : NIGMS NIH HHS
ID : K23 GM110469
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL087738
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002243
Pays : United States
Investigateurs
Thomas Atwater
(T)
Jeanette Berg
(J)
Lisa N Flemmons
(LN)
Stephen J Halliday
(SJ)
Justin C Hewlett
(JC)
Luke E Habegger
(LE)
Luis E Huerta
(LE)
V Eric Kerchberger
(VE)
Emily Kocurek
(E)
Matthew F Mart
(MF)
Andrew C Mckown
(AC)
Christopher M Merrick
(CM)
Christina C Noblit
(CC)
Li Wang
(L)
Erin M Wilfong
(EM)
Nichelle I Winters
(NI)
Ross Hoffman
(R)
Naveen Turlapati
(N)
Sneha Samant
(S)
Page Clark
(P)
Amita Krishnan
(A)
Joseph Gresens
(J)
Cody Hill
(C)
Bobby Matthew
(B)
Jason Henry
(J)
Jason Miller
(J)
Rose Paccione
(R)
Abdulla Majid-Moosa
(A)
Jairo I Santanilla
(JI)
William S Stigler
(WS)
Jason Fain
(J)
Bryan Garcia
(B)
David Lafon
(D)
Chao He
(C)
James O'Connor
(J)
David Campbell
(D)
Jordan Powner
(J)
Samuel McElwee
(S)
Cristina Bardita
(C)
Kevin D'Souza
(K)
G Bruno Pereira
(GB)
Sarah Robison
(S)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Massachusetts Medical Society.
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