RCT

PREOXI

Noninvasive Ventilation for Preoxygenation during Emergency Intubation

NEJM, 2024 · Multicenter randomized trial (n=1301)

Clinical question

Does NIV preoxygenation reduce peri-intubation hypoxemia compared with an oxygen mask in critically ill adults?

Population: Critically ill adults undergoing emergency tracheal intubation
Intervention: Noninvasive ventilation for preoxygenation
Comparator: Oxygen mask preoxygenation
Primary outcome: Hypoxemia (SpO2 <85%) from induction through 2 minutes after intubation
Result: Hypoxemia occurred in 9.1% with NIV vs 18.5% with oxygen mask (P<0.001).

What the trial found

NIV preoxygenation substantially reduced peri-intubation hypoxemia.

Current guideline position

High-value contemporary ICU airway evidence.

Clinical interpretation

Use NIV preoxygenation when clinically appropriate and not contraindicated, especially in patients at high risk of desaturation.

Clinical Context & Relevant Topics (1)

Disease Reference

Airway Management & Rapid Sequence Intubation

The 7 Ps of ICU intubation, the physiologically difficult airway, BOUGIE/DEVICE video laryngoscopy trials, hemodynamic optimization, waveform capnography, and scalpel-bougie cricothyroidotomy.

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