Hypoxemia during intubation raises the risk of cardiac arrest and death in critically ill patients. The PREOXI trial asked whether preoxygenating with noninvasive ventilation (NIV) reduces it compared with the usual oxygen mask.
The study
A randomized, pragmatic, unblinded trial in 24 emergency departments and intensive care units in the United States with 1,301 adults (Gibbs et al., N Engl J Med 2024). The primary outcome was hypoxemia, defined as oxygen saturation below 85% between induction and 2 minutes after intubation.
| Outcome | NIV | Oxygen mask |
|---|---|---|
| Hypoxemia (SpO₂ < 85%) | 9.1% (57/624) | 18.5% (118/637) |
| Cardiac arrest | 0.2% (1 patient) | 1.1% (7 patients) |
| Aspiration | 0.9% (6) | 1.4% (9) · difference not significant |
Taking it to training
Preoxygenation is a step of the procedure, not a formality: in simulation you can practice the setup, interface fit and team communication before induction.
Sources
- Gibbs KW, Semler MW, Driver BE, et al. Noninvasive ventilation for preoxygenation during emergency intubation. N Engl J Med 2024;390:2165-2177. doi:10.1056/NEJMoa2313680
- The Bottom Line · PREOXI
- REBEL EM · The PREOXI trial
Image: “Join the OxyGENation” poster, courtesy of PAC (The Protected Airway Collaborative).
Educational content; it does not replace clinical judgment or your institution's guidelines.