{"id":28466,"date":"2025-07-31T04:48:00","date_gmt":"2025-07-30T20:48:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=28466"},"modified":"2025-07-31T06:07:19","modified_gmt":"2025-07-30T22:07:19","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e8%82%ba%e9%83%a8%e5%81%a5%e5%ba%b7%e5%bf%97%e6%84%bf%e8%80%85%e9%87%87%e7%94%a8%e4%bc%b4%e6%9c%89peep%e6%88%96%e4%b8%8d%e4%bc%b4peep","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=28466","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u80ba\u90e8\u5065\u5eb7\u5fd7\u613f\u8005\u91c7\u7528\u4f34\u6709PEEP\u6216\u4e0d\u4f34PEEP\u7684\u9884\u6c27\u5408"},"content":{"rendered":"\n<p>Original Investigation&nbsp;<\/p>\n\n\n\n<p>Emergency Medicine<\/p>\n\n\n\n<p>May&nbsp;20,&nbsp;2025<\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Preoxygenation With and Without Positive End-Expiratory Pressure in Lung-Healthy Volunteers: A Randomized Clinical Trial<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Giulia&nbsp;Roveri,&nbsp;Anna&nbsp;Camporesi,&nbsp;Alex&nbsp;Hofer,&nbsp;et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><em>JAMA Netw Open.&nbsp;<\/em>2025;8(5):e2511569. doi:10.1001\/jamanetworkopen.2025.11569<\/h3>\n\n\n\n<p><a><\/a>Key Points<\/p>\n\n\n\n<p><strong>Question<\/strong>&nbsp;&nbsp;Is there a difference in the efficacy of 3 preoxygenation devices for use in emergency medicine\u2014nonrebreather mask (NRM), bag-valve mask (BVM), and BVM with positive end-expiratory pressure (BVM plus PEEP)\u2014in lung-healthy volunteers?<\/p>\n\n\n\n<p><strong>Findings<\/strong>&nbsp;&nbsp;In this crossover randomized clinical trial of 53 volunteers, including adults with normal weight, adults with overweight or obesity, and children aged 6 to 12 years, BVM and BVM plus PEEP achieved higher expiratory oxygen concentration compared with NRM. BVM plus PEEP improved ventilation in dependent lung regions.<\/p>\n\n\n\n<p><strong>Meaning<\/strong>&nbsp;&nbsp;These findings suggest that adding PEEP to BVM may improve preoxygenation of patients undergoing emergency intubation.<a><\/a><\/p>\n\n\n\n<p>Abstract<\/p>\n\n\n\n<p><strong>Importance<\/strong>&nbsp;&nbsp;Optimal preoxygenation is critical in emergency medicine to prevent desaturation during airway management, especially in high-risk populations. Identifying the most effective preoxygenation device across diverse patient groups remains a clinical priority.<\/p>\n\n\n\n<p><strong>Objective<\/strong>&nbsp;&nbsp;To compare the efficacy of 3 preoxygenation devices\u2014nonrebreather mask (NRM), bag-valve mask (BVM), and BVM with positive end-expiratory pressure (BVM plus PEEP)\u2014in lung-healthy volunteers.<\/p>\n\n\n\n<p><strong>Design, Setting, and Participants<\/strong>&nbsp;&nbsp;This crossover randomized clinical trial was conducted from May 26 to 31, 2024, at Eurac Research, Bolzano, Italy. Volunteer participants included lung-healthy adults with normal weight (NM), adults with overweight or obesity (OW-OB), and children aged 6 to 12 years.<\/p>\n\n\n\n<p><strong>Exposures<\/strong>&nbsp;&nbsp;Preoxygenation using each device (NRM, BVM, BVM plus PEEP) with 15 L\/min of oxygen for a duration of 3 minutes in a randomized order.<\/p>\n\n\n\n<p><strong>Main Outcomes and Measures<\/strong>&nbsp;&nbsp;The primary outcome was expiratory oxygen concentration (Feo<sub>2<\/sub>) at the end of preoxygenation. Secondary outcomes included ventilation in dependent lung regions assessed using electrical impedance tomography, noninvasive continuous monitoring of oxygenation status (oxygenation reserve index [ORI]) at the end of preoxygenation, and the time taken for ORI to return to baseline values.<\/p>\n\n\n\n<p><strong>Results<\/strong>\u00a0\u00a0The study included 53 participants, 39 male (74%) and 14 female (26%), of whom 16 were adults with NW (mean [SD] age, 36 [11] years), 18 were adults with OW-OB (mean [SD] age, 45 [11] years), and 19 were children (mean [SD] age, 8 [3] years). Mean (SD) Feo<sub>2<\/sub>\u00a0at the end of preoxygenation was higher with BVM and BVM plus PEEP compared with NRM in adults with NW (72.1% [5.9%] and 75.6% [4.3%], respectively, vs 52.5% [6.1%];\u00a0<em>P<\/em>\u2009&lt;\u2009.001), adults with OW-OB (65.8% [10.4%] and 73.0% [6.4%], respectively, vs 51.9% [6.1%];\u00a0<em>P<\/em>\u2009&lt;\u2009.001), and children (64.6% [13.4%] and 67.5% [10.2%], respectively, vs 38.5% [7.5%];\u00a0<em>P<\/em>\u2009&lt;\u2009.001). Ventilation in dependent lung regions was higher with BVM plus PEEP than NRM in adults with NW (BVM plus PEEP, 51.9 [9.3] vs NRM, 47.0 [5.7];\u00a0<em>P<\/em>\u2009=\u2009.03) and children (BVM plus PEEP, 53.0 [7.3] vs NRM, 47.7 [7.0];\u00a0<em>P<\/em>\u2009=\u2009.002). ORI at the end of preoxygenation was higher with BVM plus PEEP than with NRM in adults with OW-OB (BVM plus PEEP, 0.79 [0.13] vs NRM, 0.73 [0.13];\u00a0<em>P<\/em>\u2009&lt;\u2009.001). Additionally, the mean (SE) time for ORI to return to baseline was longer with BVM plus PEEP compared with NRM in both adults with OW-OB (BVM plus PEEP, 196 [74] seconds vs NRM, 158 [53] seconds;\u00a0<em>P<\/em>\u2009=\u2009.01) and children (BVM plus PEEP, 115 [59] seconds vs NRM, 62 [36] seconds;\u00a0<em>P<\/em>\u2009&lt;\u2009.001).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jamanetworkopen\/939603\/zoi250394f1_1747095359.85188.png?Expires=1753799610&amp;Signature=pHH8RwGhkJh88wmyv9kN99MdWSRrBUynOc7Q~SbUkn5YBbE~c1hhQIDlO~giQgJWrIOQJ12MRI5c8uo2G7h24nEU31AgqeXhIRZZbBZBPuPseEbqSZX0~iWRB9EkclDm1WQAl5yPYk9EyOZPrBYVSzc~Iq9b-CjeM-x3Y804j4JNM-7s6ekTMrQyjTzE2zNHDxwmvyucP-d~lcFPWlXp8PIgjZK7Tms5lJDczhSezA9yte~PoIDx4ltlSvyu-XZIBuBcIKBB5wnH6hkwl8dS9KVrKfbg72NEfy3rosW-672nt8ty7u4~urcVaZT1IeRvh4orSahBkb-5vJ4lAt40zQ__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jamanetworkopen\/939603\/zoi250394f2_1747095359.87688.png?Expires=1753799610&amp;Signature=vQyFSbohp43D0pElJ3i7ayrDmwD3G9uKFN~rENSAJ7xmImXuJtLKT8~z38NpDu4vXCml9Xq8bxyEurcFuD5Pp3CYf6FpuPM7ol3o3lqQtKylpfysCp8FuaCY7qIwwHUsD7IS7CpzKAdGa4L2L4OPTgZocUo-S1POOJkUq4aZuzOSmOGTv2yBZbDygi-OYn7Zr9G~klQ5NP9eoyRFkwAXS9S6BcwnlTRYd8i9b6Yr5IhbTucDliXia1GEY3rJnTFpWxpSx-FH1MF-h-uxVkggXgFeITbvZ0pfEt6kA-offIqLC8P2gi82sq9TVU9tX-0IF1WPvCokyka21QPQgJzIxw__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jamanetworkopen\/939603\/zoi250394t1_1747095359.83688.png?Expires=1753799610&amp;Signature=MRu4ICfCMlb1kESUdjiHeXM8LR0vbTDQeiKToAzikHgRatdM8gZnYceOh2RmZKx~ir4OhUNIxP53yA9QLVc45Dz8SztuIEyaHn9oYdWjUS~a1KCIoA1Bo3iqEGGqS0dLwiyOkgq2u1nA-1TbCm4CxSnU3Lpqfi0XL4ARm81LG0vb82N3UhV~w77vmixM3A5Uv3ZD6TU1mLMHWtULijTHcLqRaxFGpbiUWyysCDIJjr9ixxSKtWFloKV1y~80bm7v0uEb3AQ1cCrZ1a3DjG0k6qMalJHIy69weZR98JXqILygFL1m6L1sTd4-X8DEgk6tdVZTxDrylBP3UH3aS5lUTw__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jamanetworkopen\/939603\/zoi250394t2_1747095359.86188.png?Expires=1753799610&amp;Signature=RAIPzRBu5rt6g7ejsukr5X1p6aRfAO2WcVCstq7h~0PqAVztdZpi4sp147lLleFCO1CwcdSMi39HmVxIwTseU1Bbtc-hl0K1S4-IguZxWjgxDGzuhfGMhmHAhW~T~wCHL6bE08LYJAlxdjVhuZHZl~5uGJPHNZLcQ89FPtAQCH1KCPHvyb4AFTSQG4gg7wW50pGp4suzC1ez5XRcW9WQZRVZXgs7acL~qkZ5YByTku0NZ7hOwe0UuAU3wChq98IUm-nmDSsLIKulysDnsCln4gqKtJjp7axscRoz5DF-kzPZK9hxH0S~2ajZsX4Z6U7PRw3FbR4Zh6UZONc-~vLXkQ__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<p><strong>Conclusions and Relevance<\/strong>&nbsp;&nbsp;In this crossover randomized clinical trial, preoxygenation with PEEP was more effective than preoxygenation without PEEP, resulting in higher Feo<sub>2<\/sub>&nbsp;values and improved ventilation in dependent lung regions. These findings suggest that BVM plus PEEP should be prioritized for preoxygenation in emergency settings.<\/p>\n\n\n\n<p><strong>Trial Registration<\/strong>&nbsp;&nbsp;ClinicalTrials.gov Identifier:&nbsp;<a href=\"https:\/\/clinicaltrials.gov\/study\/NCT06370689\">NCT06370689<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Original Investigation&nbsp; Emergency Medicine May&#038;nbs [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28466"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28466"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28466\/revisions"}],"predecessor-version":[{"id":28728,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28466\/revisions\/28728"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28466"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=28466"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=28466"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}