Jonathan D Casey1, David R Janz1, Derek W Russell1, Derek J Vonderhaar1, Aaron M Joffe1, Kevin M Dischert1, Ryan M Brown1, Aline N Zouk1, Swati Gulati1, Brent E Heideman1, Michael G Lester1, Alexandra H Toporek1, Itay Bentov1, Wesley H Self1, Todd W Rice1, Matthew W Semler1. 1. From the Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine-New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) - both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle.
Abstract
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 undergoingtracheal 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 receivingbag-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.).
RCT Entities:
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.).
Authors: Achim von Goedecke; Volker Wenzel; Christoph Hörmann; Wolfgang G Voelckel; Horst G Wagner-Berger; Angelika Zecha-Stallinger; Thomas J Luger; Christian Keller Journal: J Emerg Med Date: 2006-01 Impact factor: 1.484
Authors: M Dietrich; C J Reuß; C Beynon; A Hecker; C Jungk; D Michalski; C Nusshag; K Schmidt; M Bernhard; T Brenner; M A Weigand Journal: Anaesthesist Date: 2019-11 Impact factor: 1.041
Authors: Stephen J Halliday; Jonathan D Casey; Todd W Rice; Matthew W Semler; David R Janz; Derek W Russell; James Dargin; Derek J Vonderhaar; Jason R West; Matthew M Churpek Journal: Ann Am Thorac Soc Date: 2020-08
Authors: Alan H Morris; Brian Stagg; Michael Lanspa; James Orme; Terry P Clemmer; Lindell K Weaver; Frank Thomas; Colin K Grissom; Ellie Hirshberg; Thomas D East; Carrie Jane Wallace; Michael P Young; Dean F Sittig; Antonio Pesenti; Michela Bombino; Eduardo Beck; Katherine A Sward; Charlene Weir; Shobha S Phansalkar; Gordon R Bernard; B Taylor Thompson; Roy Brower; Jonathon D Truwit; Jay Steingrub; R Duncan Hite; Douglas F Willson; Jerry J Zimmerman; Vinay M Nadkarni; Adrienne Randolph; Martha A Q Curley; Christopher J L Newth; Jacques Lacroix; Michael S D Agus; Kang H Lee; Bennett P deBoisblanc; R Scott Evans; Dean K Sorenson; Anthony Wong; Michael V Boland; David W Grainger; Willard H Dere; Alan S Crandall; Julio C Facelli; Stanley M Huff; Peter J Haug; Ulrike Pielmeier; Stephen E Rees; Dan S Karbing; Steen Andreassen; Eddy Fan; Roberta M Goldring; Kenneth I Berger; Beno W Oppenheimer; E Wesley Ely; Ognjen Gajic; Brian Pickering; David A Schoenfeld; Irena Tocino; Russell S Gonnering; Peter J Pronovost; Lucy A Savitz; Didier Dreyfuss; Arthur S Slutsky; James D Crapo; Derek Angus; Michael R Pinsky; Brent James; Donald Berwick Journal: J Am Med Inform Assoc Date: 2021-06-12 Impact factor: 4.497
Authors: David R Janz; Jonathan D Casey; Matthew W Semler; Derek W Russell; James Dargin; Derek J Vonderhaar; Kevin M Dischert; Jason R West; Susan Stempek; Joanne Wozniak; Nicholas Caputo; Brent E Heideman; Aline N Zouk; Swati Gulati; William S Stigler; Itay Bentov; Aaron M Joffe; Todd W Rice Journal: Lancet Respir Med Date: 2019-10-01 Impact factor: 30.700