ORIGINAL ARTICLE

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

Jonathan D. Casey, David R. Janz, Derek W. Russell, et al 

N Engl J Med February 18, 2019
DOI: 10.1056/NEJMoa1812405

BACKGROUND 背景

Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial.

低氧血症是成年危重病患者气管插管过程中最常见的并发症，可能增加心跳骤停几死亡风险。成年危重病患者气管插管过程中，通过球囊面罩装置进行正压通气能否预防低氧血症且不增加误吸风险尚存在争议。

METHODS 方法

In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%.

这是在美国7个ICU进行的一项多中心随机临床试验。我们将接受气管插管的成年患者随机分组，在诱导及喉镜操作阶段分别接受球囊面罩通气或无通气。主要预后终点为诱导至气管插管后2分钟内的最低氧饱和度。次要预后终点为严重低氧血症发生率，定义为氧饱和度< 80%。

RESULTS 结果

Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P=0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P=0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P=0.73).

研究共入选401名患者，球囊面罩组最低氧饱和度中位数为96%（四分位区间 87 to 99），无通气组为93%（四分位区间81 to 99）(P=0.01)。球囊面罩组21名患者(10.9%)及无通气组45名患者(22.8%)发生严重低氧血症（相对危险度，0.48；95% 可信区间 [CI], 0.30 to 0.77）。操作者报告误吸发生率在球囊面罩组和无通气组分别为2.5%和4.0% (P=0.41)。气管插管后48小时胸片新发透光度下降的发生率分别为16.4%和14.8% (P=0.73)。

CONCLUSIONS 结论

Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation.

对于接受气管插管的成年危重病患者，与无通气相比，球囊面罩通气能够提高氧饱和度，且降低严重低氧血症的发生率。

(Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.)