Dr. Kevin Gibbs discusses the PREOXI Trial comparing preoxygenation techniques, emphasizing its impact on reducing complications in emergency tracheal intubation. The importance of preoxygenating critically ill patients to prevent complications like hypoxemia is highlighted, along with the benefits of non-invasive ventilation in critical care settings. The podcast explores challenges in high-risk scenarios, potential practice changes in preoxygenation strategies, and the groundbreaking study's impact on critical care practice.
Non-invasive ventilation reduces hypoxemia risk by 50%, affirming its efficacy in pre-oxygenation.
ICU and emergency departments may benefit from using non-invasive pre-oxygenation, impacting practice positively.
High-flow nasal cannula's exclusion in the study highlights the need for further investigation into alternative pre-oxygenation methods.
Deep dives
Patients in ICU vs. OR Intubation
Critically ill patients have a 10 to 24 times higher rate of complications during intubation compared to patients in the operating room. The procedures, while similar, are not the same, and the risks differ significantly between these patient populations.
Impact of Pre-oxygenation Study
The study focused on comparing two pre-oxygenation strategies before intubation, emphasizing the importance of pre-oxygenation in reducing the risk of hypoxemia during emergency tracheal intubation. The research aimed to evaluate the effectiveness of pre-oxygenation methods in reducing complications.
Findings of Pre-oxygenation Study
Pre-oxygenation with non-invasive ventilation reduced the rate of hypoxemia by approximately 50% compared to pre-oxygenation with an oxygen mask. The absolute risk reduction between the two methods was around 9%, highlighting the significant impact of non-invasive pre-oxygenation.
Practice Implications and Implementation
The study outcomes suggest that the use of non-invasive ventilation for pre-oxygenation is feasible, safe, and leads to better patient outcomes. While the practice change may be more affirming for ICU settings, it holds the potential to be truly practice-changing in emergency departments, where non-invasive pre-oxygenation was less common.
Role of High-Flow Nasal Cannula
The study did not include high-flow nasal cannula (HFNC) as a pre-oxygenation method, focusing primarily on non-invasive ventilation and oxygen masks. HFNC usage in pre-oxygenation warrants further investigation, considering the challenges of additional equipment, implementation barriers, and existing practice patterns. The study's emphasis on non-invasive ventilation signals a shift towards safer and more effective pre-oxygenation practices.
Extra Extra - Read All About It!! It is our pleasure to bring to you - hot off the presses - the results from the PREOXI Trial which looks at whether or not preoxygenation with non-invasive positive pressure ventilation results in better peri-intubation outcomes versus non-pressurized preoxygenation strategies. Joining us is the primary author on this paper, Dr. Kevin Gibbs, MD of Wake Forest University School of Medicine. Practice changing? Practice affirming? Does it even matter?! Check out our interview with Dr. Gibbs and see what you think! Leave us a comment and let us know if this is going to impact your practice in the ICU and beyond!