Preventing Hypoxemia With Manual Ventilation During Endotrachial Intubation - PreVent

Mar 25, 2019
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Vanderbilt Institute for Clinical and Translational Research
Date Published:
02/27/2019
Date Updated:
03/25/2019
Original Posted Date:
03/25/2019
References

Contribution To Literature:

The PreVent trial showed that bag-mask ventilation was associated with higher oxygen saturations than no ventilation.

Description:

The goal of the trial was to evaluate bag-mask ventilation compared with no ventilation among critically ill patients undergoing endotracheal intubation.


Study Design

  • Randomized
  • Parallel

Critically ill patients undergoing endotracheal intubation were randomized to bag-mask ventilation during the interval from induction to laryngoscopy (n = 199) versus no ventilation during this interval (n = 202).

  • Total number of enrollees: 401
  • Duration of follow-up: In-hospital
  • Mean patient age: 59 years
  • Percentage female: 41%

Inclusion criteria:

  • Critically ill patients undergoing endotracheal intubation

Exclusion criteria:

  • Pregnant
  • Incarcerated

Principal Findings:

The primary outcome, the median lowest oxygen level observed between induction and 2 minutes after endotracheal intubation, was 96% of the bag-mask group compared with 93% of no ventilation group (p = 0.01).

Secondary outcomes:

  • Severe hypoxemia: 10.9% of the bag-mask group vs. 22.8% of the no ventilation group (p < 0.05)
  • Operator-reported aspiration: 2.5% of the bag-mask group vs. 4.0% of the no ventilation group (p = 0.41)

Interpretation:

Among critically ill patients undergoing endotracheal intubation, bag-mask ventilation was associated with high oxygen levels and lower incidence of severe hypoxemia during the time of intubation. Operator-reported aspiration was similar between groups. This trial was conducted because of concern that bag-mask ventilation could increase the risk of aspiration; however, this did not appear to be the case.

References:

Casey JD, Janz DR, Russell DW, et al. Bag-Mask Ventilation During Tracheal Intubation of Critically Ill Adults. N Engl J Med 2019;380:811-21.

Editorial: Kritek PA, Luks AM. Preventing Dogma From Driving Practice. N Engl J Med 2019;380:870-1.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Critical Illness, Hypoxia, Brain, Intubation, Intratracheal, Laryngoscopy, Masks, Oxygen, Respiration, Artificial, Secondary Prevention, Ventilation


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