Methodology: 4/5
Usefulness: 3.5/5
Gibbs KW, et al. N Engl J Med. 2024 Jun 20;390(23):2165-2177.
Question and Methods: The PREOXI trial aimed to determine whether noninvasive ventilation (NIV) via BiPAP reduces hypoxemia compared to standard oxygen masks for preoxygenation in critically ill adults undergoing emergency intubation through a multicenter, randomized controlled trial.
Findings: Hypoxemia occurred in 9.1% of patients in the NIV group, compared to 18.5% in the oxygen mask group, indicating a significant reduction in the incidence of hypoxemia with NIV. The incidence of cardiac arrest was lower in the NIV group (0.2%) compared to the oxygen mask group (1.1%). The occurrence of aspiration was similar between the two groups, with 0.9% in the NIV group and 1.4% in the oxygen mask group.
Limitations: The study was unblinded, performed in high-resource settings, and did not evaluate long-term patient outcomes, limiting generalizability to low-resource environments or different patient populations.
Interpretation: NIV should be considered for preoxygenation in critically ill patients undergoing intubation to reduce hypoxemia, particularly in settings with trained personnel and appropriate equipment. Added benefit is likely to be seen in patients with obesity, or those presenting with hypoxemic respiratory failure.
JC Supervisor: Dr. Christian Vaillancourt
