NONINVASIVE PREOXYGENATION BEFORE EMERGENCY INTUBATION

Orda Ayana

2026

Full text Open access: Gold Metadata (CSL-JSON)
DOI 10.70286/eoss-20.07.2026.018.229-234
Data confidence 70 medium
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Abstract

Background. In critically ill adults, hypoxemia is a frequent occurrence during emergency tracheal intubation and can be a source of cardiac arrest and other major adverse events. The benefits of noninvasive ventilation (NIV) for preoxygenation have been inconsistent in terms of size and clinical relevance. Objective. To measure the relationship between NIV preoxygenation and peri-intubation hypoxemia with anonymized pooled data from randomized trials. Methods. A rapid systematic search of PubMed/MEDLINE, ClinicalTrials.gov, journal websites, and reference lists was performed. Randomized studies involving adults in critical condition who were undergoing emergency intubation comparing NIV to conventional oxygen-mask preoxygenation were included. Risk ratios (RR), risk difference (RD), 95% confidence interval (CI), and number needed to treat (NNT) were computed. When an event count was available, a random-effects synthesis was conducted for severe hypoxemia (SpO2 < 80%). Results. 1,555 individuals were eligible for three trials. Compatible binary data was obtained for severe hypoxemia from two trials. In both trials, NIV reduced severe hypoxemia; exploratory pooled RR 0.34 (95% CI 0.13-0.91; I2=54%). Hypoxemia < 85% was present in 9.1% of the patients in PREOXI using NIV and in 18.5% of the patients using an oxygen mask (absolute decrease of 9.4, NNT 11). Conclusions. The evidence base for the effect of NIV preoxygenation on periintubation hypoxemia is limited and clinically varied.