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The following is a summary of “Selective Use of Positive-Pressure Ventilation for Preoxygenation During Air Medical Rapid Sequence Intubation,” published in the December 2024 issue of Emergency Medicine by Herndon et al. 

Preoxygenation was crucial for the safe execution of rapid sequence intubation (RSI), while the use of positive-pressure ventilation (PPV) during preoxygenation, although advocated, potentially increased the risk of aspiration.  

Researchers conducted a retrospective study to evaluate the risk-benefit profile of using PPV during air medical RSI.  

They analyzed data from the Air Methods Airway Registry, including records from over 175 bases across the U.S. over 5 years. Individuals were categorized as normoxemic (SpO₂≥93%) or hypoxemic (SpO₂ <93%) and compared based on demographics, clinical data, and the use of PPV. The primary outcomes were first-attempt intubation success (FAS) and FAS without desaturation (FASWD). Statistical methods included chi-square tests, t-tests, and logistic regression.  

The results showed that 9,778 individuals underwent intubation, FAS was 92% (8,966 individuals), and FASWD was 90% (8,775 individuals). The mean SpO₂) was 94.9%, PPV was administered to 42% (4,118 individuals) before intubation, with 1% (94 individuals) experiencing aspiration during RSI. Multivariate logistic regression indicated that PPV was linked to reduced intubation success in normoxemic individuals but improved success in individual’s hypoxemia, with a higher aspiration risk (P = 0.007).  

Investigators concluded the PPV during preoxygenation was beneficial for individuals with hypoxemia but not for normoxemic due to reduced intubation success and increased aspiration risk. 

Source: sciencedirect.com/science/article/abs/pii/S0736467924002117