A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study the use of bag-mask ventilation to prevent hypoxemia during intubation.  401 patients were randomized to either bag mask ventilation or no ventilation between induction and laryngoscopy.

Image result for bag valve mask intubation

The median lowest oxygen saturation in the BVM group was 96% and 93% in the no-ventilation group.  10.9% of the BVM group had severe hypoxemia where was 23% in the no-ventilation group experienced severe hypoxemia.

Crucially, operator-reported aspiration occurred in 2.5% of intubations in the BVM group and 4.0% in the no-ventilation group.  This is of particular significance given that aspiration of gastric contents is often touted as the theoretical hazard of post-induction bag-mask ventilation.

Bottom line: When intubating sick patients, this study suggests that patients receiving bag mask ventilation experience less critical hypoxemia and higher oxygen saturations than those receiving no ventilation.

Will it change your practice?  Perhaps it ought to.

July 2022
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