Study reference

Study characteristics

Patient characteristics 

Intervention (I)

Comparison / control (C)

Follow-up

Outcome measures and effect size

Comments

Caputo, 2017

ENDAO trial

NCT 02737917

Type of study:

RCT

Setting and country:

Single center, ED, USA

Funding and conflicts of interest:

The authors have no relevant financial information or potential conflicts to disclose.

Inclusion criteria:

Any adult patient (age > 18 years old) presenting to the

ED requiring endotracheal intubation was screened for

inclusion into the study.

Exclusion criteria:

Patients were excluded from

the study if they were not preoxygenated to the standard

RSI protocol of a goal of 3 minutes with 100% FiO2 by

means of BVM, BiPAP, and/or NRB; if they were in cardiac or traumatic arrest; or if they were intubated

without an apneic period (i.e., awake intubation).

Patients who did not undergo preoxygenation were excluded to avoid a potential confounding variable.

N total at baseline:

I: 104

C: 102

Important prognostic factors²:

Age, mean:

I: 54.2

C: 55.1

Sex:

I: 58% M

C: 59% M

ASA (mean

I: 2.67

C: 2.69

Groups were comparable at baseline.

Apnoeic oxygenation by nasal cannula

Supplemental oxygen via nasal cannula; (CareFusion AirLife) and NC EtCO2 (Phillips, Smart Capnoline), both at flush flow rates ≥15 LPM (providing intra and extra nasal oxygen) during laryngoscopy

Usual care

No supplemental oxygen during laryngoscopy

Length of follow-up:

24 hours

Loss-to-follow-up:

None

Incomplete outcome data:

N/A

Critical outcome measures

Desaturation: lowest SpO2

Lowest SpO2 during the apnea period or in the 2 minutes after, mean, 95% CI

I: 92, 91-93

C: 93, 92-94

Desaturation: incidence of low SpO2

Incidence of SpO2 <90%, no. (%)

I: 17/100 (17%)

C:  15/100 (15%)

Duration of SpO2 < 80%

I: 3/100 (3%)

C:  4/100 (4%)

Important outcome measures

Hypotension

Not reported

Cardiac arrest

Not reported

Aspiration

Not reported

Mortality

Mortality at 24h, no. (%)

I: 4/100, 4%

C: 2/100, 2%

Total mortality, no. (%)

(time not specified)

I: 14/100, 14%

C: 16/100, 16%

Authors’ conclusions:

this study demonstrated that in patients that are properly preoxygenated during rapid sequence intubation in the ED, the application of apneic oxygenation did not lead to any differences in lowest

mean oxygen saturation, desaturation rates between

the two groups, or intubation success without hypoxemia.

Casey, 2019

PreVent

NCT 03026322

Type of study:

RCT

Setting and country: Multicenter, USA, ICU

Funding and conflicts of interest: Supported by grants (UL1 TR000445 and UL1TR002243) from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), to the Vanderbilt Institute for Clinical and Translational Research. Dr. Casey was supported, in part, by a grant (2T32HL087738–12) from the NIH; Dr. Semler, by grants (K12HL133117 and K23HL143053) from the National Heart, Lung, and Blood Institute (NHLBI); Dr. Russell, by a grant (T32HL105346–07) from the NHLBI; and Dr. Rice, by a grant (R34HL105869) from the NIH.

Dr. Self reports receiving advisory board fees from Cempra Pharmaceuticals, Ferring Pharmaceuticals, Biotest, and Merck and travel support from Gilead Pharmaceuticals and Pfizer; and Dr. Rice, receiving consulting fees and fees for serving as director of medical affairs from Cumberland Pharmaceuticals, consulting fees from Avisa Pharma, and fees for serving as chair of a data and safety monitoring board from Takeda Pharmaceuticals. No other potential conflict of interest relevant to this article was reported.

Inclusion criteria:

Adults (age, ≥18 years) undergoing induction and tracheal intubation.

Exclusion criteria:

Patients were excluded if they were pregnant, were incarcerated, or had such an immediate need for tracheal intubation that randomization was precluded or if the treating clinicians had determined that ventilation between induction and laryngoscopy was either required (e.g., as a treatment for hypoxemia or severe acidemia) or contraindicated (e.g., because of an increased risk of aspiration from ongoing emesis, hematemesis, or hemoptysis).

N total at baseline:

I: 199

C: 202

Important prognostic factors²:

Age, median:

I: 59

C: 60

Sex:

I: 59% M

C: 54% M

Body mass index, median, kg/m2

I: 27.1

C: 27.6

APACHE II, median

I: 22

C: 22

Groups were comparable at baseline.

Bag-mask ventilation

bag-mask ventilation was provided by treating clinicians during the interval from induction until the initiation of laryngoscopy. oxygen flow rates of at least 15 liters per minute, a valve attached to the expiratory port of the bag-mask device to generate a positive end-expiratory pressure of 5 to 10 cm of water, an oropharyngeal airway, a two-handed mask seal performed by the intubating clinician with a head-tilt and chin-lift maneuver, and ventilation at 10 breaths per minute with the smallest volume required to generate a visible chest rise

No ventilation

For patients who were assigned to the no-ventilation group, bag-mask ventilation between induction and laryngoscopy was not permitted, except after a failed attempt at laryngoscopy, as treatment for hypoxemia (oxygen saturation, <90%), or at any point if the treating

clinicians determined that such treatment was necessary for the safety of the patient.

All methods of preoxygenation, including noninvasive ventilation, were allowed in either group before induction

Length of follow-up:

Intubation procedure

Loss-to-follow-up:

none

Incomplete outcome data:

N/A

Critical outcome measures

Desaturation: lowest SpO2

Lowest SpO2, median (IQR)

I: 96 (87-99)

C: 93 (81-99)

Desaturation: incidence of low SpO2

Incidence of SpO2 <90%, no. (%)

I: 57/193 (29.5%)

C:  79/197 (40.1%)

Duration of SpO2 < 70%

I: 8/193 (4.1%)

C: 20/197 (10.2%)

Important outcome measures

Hypotension

New systolic blood pressure of<65 mm Hg

no. (%)

I: 8/195 (4.1%)

C: 17/197 (8.6%)

Cardiac arrest

Within 1h of intubation

no. (%)

I: 2 (1.0%)

C: 6 (2.0%)

Aspiration

operator-reported aspiration

I: 2.5%; 5/199

C: 4.0%; 8/202

RR 0.63 (95% CI 0.21 to 1.91)

Mortality

Mortality on discharge, no. (%)

I: 71 (35.7%)

C: 72 (35.6%)

Authors’ conclusions:

in this multicenter, randomized trial involving critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation during the interval between induction and laryngoscopy had higher oxygen saturations and lower rates of severe hypoxemia than those receiving no ventilation.

Jaber, 2016

OPTINIV

NCT 02530957

Type of study:

RCT

Setting and country:

Funding and conflicts of interest:

Inclusion criteria:

Patients admitted to the ICU and requiring mechanical

ventilation through an orotracheal tube

Exclusion criteria:

Patients fulfilling one or more of the following criteria were not included: age less than 18 years, pregnant or breastfeeding woman, protected person, intubation procedures in case of cardio-circulatory arrest, nasopharyngeal obstruction contraindicating the use of HFNC, and usual contraindications to NIV.

N total at baseline:

I: 25

C: 24

Important prognostic factors²:

Age, mean:

I: 63

C: 61

Sex:

I: 72% M

C: 83% M

Body mass index, mean (SD), kg/m2

I: 24

C: 23

MACOCHA score <3

I: 92%

C: 83%

Groups were comparable at baseline.

4 min preoxygenation

at 30° of head-up inclination with HFNC (humidified

oxygen flow of 60 L/min, FiO2 = 100 %) combined

with NIV (PS of 10 cmH2O, PEEP of 5 cmH2O,

FiO2 = 100 %)

4 min preoxygenation at

30° of head-up inclination with NIV only (same parameters as in the interventional group) without HFNC (nasal

cannula positioned without any flow)

Length of follow-up:

Intubation procedure

Loss-to-follow-up:

None

Incomplete outcome data:

N/A

Critical outcome measures

Desaturation: lowest SpO2

Lowest SpO2 during intubation, median (IQR)

I: 100 (95–100)

C: 96 (92–99)

Desaturation: incidence of low SpO2

Incidence of SpO2 <90%

Not reported

Incidence of SpO2 < 80%

I: 1/25 (4%)

C: 5/24 (21%)

Important outcome measures

Hypotension

Not reported

Cardiac arrest

Not reported

Aspiration

I: 0%

C: 0%

Mortality

Day 28

I: 8/25, 32.0%

C: 9/24, 37.5%

Authors’ conclusions:

HFNC combined with NIV, in comparison to NIV alone, allowed significantly higher minimal SpO2 values

during the intubation procedure of severe hypoxaemic acute respiratory failure ICU patients. This proof-of-concept study has to be confirmed with a large multicentre randomised controlled trial.

Shahul Hameed, 2024

Type of study:

RCT

Setting and country: single‑center, ED, India

Funding and conflicts of interest:

No funding.

No conflict of interest declared.

Inclusion criteria:

Patients aged 18 years and above, presenting to the ED with AHRF (defined as hypoxemia with PaO2 < 60 mmHg or a 20% drop in saturation from baseline with an indication for intubation).

Exclusion criteria:

Relatives of patients unwilling or unable to provide consent for study participation, pregnant individuals, contraindications to nasopharyngeal cannula insertion (nasopharyngeal obstruction or blockage, nasal bone fractures, and base of skull fractures), and challenging airways characterized by limited neck mobility, restricted mouth opening, or a Mallampati score > 2.

N total at baseline:

I: 38

C: 38

Important prognostic factors²:

Age, mean±SD:

I: 48±2.8

C: 44±2.5

Sex:

I: 57.1% F

C: 42.9% F

Groups were comparable at baseline.

Oxygenation through a nasopharyngeal cannula (15 l) in conjunction

with BVM preoxygenation

Standard BVM preoxygenation alone

Both groups underwent a 3 min preoxygenation period

before the initiation of apneic oxygenation

Length of follow-up:

ED discharge

Loss-to-follow-up:

None

Incomplete outcome data:

N/A

Critical outcome measures

Desaturation: lowest SpO2

lowest SpO2 levels postintubation (0 min), median (IQR)

I: 95.5 (80-99)

C: 89 (76-98)

Desaturation: incidence of low SpO2

Not reported

Duration of SpO2 < 80%

Not reported

Important outcome measures

Hypotension

Not reported

Cardiac arrest

Not reported

Aspiration

Not reported

Mortality

Mortality in ED, no. (%)

I: 20/38 (52.6)

C: 18/38 (47.7%)

Authors’ conclusions:

Our study involving 76 ED patients undergoing RSI

found that the intervention group did not demonstrate

a statistically significant decrease in the occurrence

of hypoxia during intubation or the prevention of

postintubation adverse events when contrasted with

the control group.

NB. The study was conducted

over 5 months, from April 2021 to August 2021, amid the COVID‑19 pandemic. Patients were enrolled without prior knowledge of their COVID‑19 infectivity status.

Semler, 2016

FELLOW trial

NCT 02051816

Type of study:

RCT

Setting and country: Single center, ICU, USA

Funding and conflicts of interest:

Supported by NHLBI T32 award (HL087738 09). Data collection used the Research Electronic Data Capture (REDCap) tool developed and maintained with Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from National Center for Advancing Translational Sciences/National

Institutes of Health). The funding institutions had no role in conception, design, or conduct of the study; collection, management, analysis, interpretation, or

presentation of the data; or preparation, review, or approval of the manuscript.

Author disclosures are available with the text of this article at atsjournals.org.

Inclusion criteria:

patients undergoing

endotracheal intubation in the medical ICU. All patients 18 years or older being

intubated by a pulmonary and critical care medicine fellow were eligible.

Exclusion criteria:

Patients were excluded if awake intubation was planned, if intubation was required so emergently that randomization could not be achieved, or if the treating clinicians believed a specific approach to intraprocedural oxygenation or a specific laryngoscopy device was mandated for the safe performance of the procedure.

N total at baseline:

I: 77

C: 73

Important prognostic factors²:

Age, median (IQR):

I: 60 (51–68)

C: 60 (50–67)

Sex:

I: 58% M

C: 63% M

Body mass index, median (IQR), kg/m2

I: 28.6 (23.3–32.8)

C: 28.6 (23.4–32.8)

APACHE II, median (IQR)

I: 22 (16–27)

C: 22 (17–27)

Groups were comparable at baseline.

Apneic oxygenation

A high-flow nasal cannula (Comfort Soft Plus; Westmed, Inc., Tucson, AZ) set to 15 L/min flow of 100% oxygen was placed in the patient’s nares before induction and kept in place until intubation was complete.

Usual care

Patients in the usual care group were intubated without supplemental oxygen during laryngoscopy.

Length of follow-up:

Hospital discharge

Loss-to-follow-up:

None

Incomplete outcome data:

N/A

Critical outcome measures

Desaturation: lowest SpO2

Lowest SpO2 during first attempt, median (IQR)

I: 92 (84–99)

N=73 were included in intention-to-treat

analysis for primary outcome

C: 90 (80–96)

N=77 were included in intention-to-treat

analysis for primary outcome

Desaturation: incidence of low SpO2

Incidence of SpO2 <90%, no. (%) at first attempt

I: 34 (44.7)

C:  34 (47.2)

Duration of SpO2 < 80%

no. (%)

I: 12 (15.8)

C: 18 (25.0)

Important outcome measures

Hypotension

Not reported

Cardiac arrest

Not reported

Aspiration

Not reported

Mortality

Mortality on discharge, no. (%)

I: 27 (35.1)

C: 36 (49.3)

Authors’ conclusions:

The results of this

clinical trial suggest that apneic oxygenation during endotracheal intubation of critically ill adults does not increase lowest arterial oxygen saturation

compared with usual care. Routine use of apneic oxygenation during emergent

intubation cannot be recommended.

Study reference

(first author, publication year)

Was the allocation sequence adequately generated?

Definitely yes

Probably yes

Probably no

Definitely no

Was the allocation adequately concealed?

Definitely yes

Probably yes

Probably no

Definitely no

Blinding: Was knowledge of the allocated

interventions adequately prevented?

Were patients blinded?

Were healthcare providers blinded?

Were data collectors blinded?

Were outcome assessors blinded?

Were data analysts blinded?

Definitely yes

Probably yes

Probably no

Definitely no

Was loss to follow-up (missing outcome data) infrequent?

Definitely yes

Probably yes

Probably no

Definitely no

Are reports of the study free of selective outcome reporting?

Definitely yes

Probably yes

Probably no

Definitely no

Was the study apparently free of other problems that could put it at a risk of bias?

Definitely yes

Probably yes

Probably no

Definitely no

Overall risk of bias

If applicable/necessary, per outcome measure

LOW

Some concerns

HIGH

Caputo, 2017

ENDAO trial

Definitely yes

The sequence of study group assignments was generated via a computerized algorithm using permuted blocks of 4, 8, and 12.

Definitely yes

Study group assignments

were placed in a secured binder and sequentially numbered

in opaque envelopes.

Probably yes

The data collectors were blinded to our study design and outcome, and we feel

that no bias was introduced by the use of these trained data collectors.

Definitely yes

Reason: Loss to follow-up was infrequent in intervention and control group.

Probably yes

Reason: All relevant outcomes were reported

Probably yes

Reason: No other problems noted

LOW

Casey, 2019

PreVent trial

Definitely yes

Patients underwent randomization in a 1:1 ratio to undergo either bag-mask ventilation or no ventilation in permuted blocks of 2, 4, and 6, stratified according to trial site.

Definitely yes

Trial-group assignments were placed in sequentially numbered opaque envelopes and remained concealed until after enrollment.

Definitely no

Given the nature of the intervention, patients, clinicians, and research personnel were aware of trial-group assignments after randomization.

Definitely yes

Reason: Loss to follow-up was infrequent in intervention and control group.

Probably yes

Reason: All relevant outcomes were reported

Probably yes

Reason: No other problems noted

SOME CONCERNS

knowledge of group assignment may have contributed to differences in preoxygenation technique between groups

Jaber, 2016

OPTINIV trial

Definitely yes

A computer-generated 1:1 randomisation was

used, generated by a statistician who was not involved

in determination of patient eligibility or outcome assessment.

No stratification was performed.

Definitely yes

Randomisation

was accomplished by using opaque sealed envelopes. The

randomisation envelopes contained a card stating the

group to which the patient was randomised.

Definitely yes

The study

was blinded to the observer collecting the data.

Definitely yes

Reason: Loss to follow-up was infrequent in intervention and control group.

Probably yes

Reason: All relevant outcomes were reported

Probably yes

Reason: No other problems noted

LOW

Shahul Hameed, 2024

Definitely yes

We used the Block Permutation Statistical Analysis System 9.4, developed by North Carolina State University, to randomize treatment allocation in block sizes of 2, 4, and 6. Randomization was accomplished through computer‑generated block randomization.

Definitely yes

Sequentially numbered opaque‑sealed envelopes were

provided to patients for allocation into the intervention

and control groups.

Definitely no

Due to the nature of the intervention, blinding of the treating clinician, ED staff,

and patients post-allocation was not feasible.

Definitely yes

Reason: Loss to follow-up was infrequent in intervention and control group.

Definitely no

Reason: Not all defined outcomes were reported in the results section.

Probably yes

Reason: No other problems noted

SOME CONCERNS

knowledge of group assignment may have contributed to differences airway

management by the clinical team. Possible selective outcome reporting.

Semler, 2016

FELLOW trial

Definitely yes

Eligible patients were randomly assigned in

a 1:1 ratio to receive apneic oxygenation or usual care. The

sequence of study group assignments was

generated via a computerized algorithm using permuted blocks of 4, 8, and 12.

Definitely yes

Study group assignments were placed in sequentially numbered opaque envelopes that remained sealed until the decision had been made that a patient required intubation and was enrolled in the study.

Definitely no

Because of the nature of the study

intervention, clinicians and study personnel were aware of study group assignments after enrollment.

Definitely yes

Reason: Loss to follow-up was infrequent in intervention and control group.

Probably yes

Reason: All relevant outcomes were reported

Probably yes

Reason: No other problems noted

SOME CONCERNS

knowledge of group assignment may have contributed to differences in approach to

preoxygenation, induction and additional airway

management equipment made by the clinical team.

Reference

Reason for exclusion

Baillard C, Prat G, Jung B, Futier E, Lefrant JY, Vincent F, Hamdi A, Vicaut E, Jaber S. Effect of preoxygenation using non-invasive ventilation before intubation on subsequent organ failures in hypoxaemic patients: a randomised clinical trial. Br J Anaesth. 2018 Feb;120(2):361-367. doi: 10.1016/j.bja.2017.11.067. Epub 2017 Nov 23. PMID: 29406184.

Wrong comparison

Baillard C, Fosse JP, Sebbane M, Chanques G, Vincent F, Courouble P, Cohen Y, Eledjam JJ, Adnet F, Jaber S. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med. 2006 Jul 15;174(2):171-7. doi: 10.1164/rccm.200509-1507OC. Epub 2006 Apr 20. PMID: 16627862.

Wrong comparison

Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Hodge A, Ryan T, White LD. Apnoeic oxygenation during intubation in the intensive care unit: A systematic review and meta-analysis. Heart Lung. 2017 Nov-Dec;46(6):452-457. doi: 10.1016/j.hrtlng.2017.08.001. Epub 2017 Sep 12. PMID: 28912057.

Original publications used

Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Bond E, White LD. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis. Am J Emerg Med. 2017 Oct;35(10):1542-1546. doi: 10.1016/j.ajem.2017.06.046. Epub 2017 Jun 24. PMID: 28684195.

Original publications used

Cabrini L, Landoni G, Baiardo Redaelli M, Saleh O, Votta CD, Fominskiy E, Putzu A, Snak de Souza CD, Antonelli M, Bellomo R, Pelosi P, Zangrillo A. Tracheal intubation in critically ill patients: a comprehensive systematic review of randomized trials. Crit Care. 2018 Jan 20;22(1):6. doi: 10.1186/s13054-017-1927-3. Erratum in: Crit Care. 2019 Oct 21;23(1):325. PMID: 29351759; PMCID: PMC5775615.

Wrong comparison

Cao L, Zheng H, Xie Y, Liu S, Liu K. [Effect of preoxygenation and apnoeic oxygenation during intubation in the critically ill patients: a network Meta-analysis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Oct;31(10):1236-1241. Chinese. doi: 10.3760/cma.j.issn.2095-4352.2019.10.011. PMID: 31771721.

Wrong language

Chua MT, Ng WM, Lu Q, Low MJW, Punyadasa A, Cove ME, Yau YW, Khan FA, Kuan WS. Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial. Ann Acad Med Singap. 2022 Mar;51(3):149-160. doi: 10.47102/annals-acadmedsg.2021407. PMID: 35373238.

Wrong comparison

Chaudhuri D, Granton D, Wang DX, Einav S, Helviz Y, Mauri T, Ricard JD, Mancebo J, Frat JP, Jog S, Hernandez G, Maggiore SM, Hodgson C, Jaber S, Brochard L, Burns KEA, Rochwerg B. Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis. Crit Care Med. 2020 Apr;48(4):571-578. doi: 10.1097/CCM.0000000000004217. PMID: 32205604.

Wrong comparison

Cırıl MF, Akarca M, Unal Akoglu E, Cimilli Ozturk T, Onur Ö. High-Flow Nasal Cannula versus Bag Valve Mask for Preoxygenation during Rapid Sequence Intubation in the Emergency Department: A Single-Center, Prospective, Randomized Controlled Trial. Prehosp Disaster Med. 2024 Feb;39(1):45-51. doi: 10.1017/S1049023X23006684. Epub 2023 Dec 18. PMID: 38108139.

Wrong comparison

Fong KM, Au SY, Ng GWY. Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials. Crit Care. 2019 Sep 18;23(1):319. doi: 10.1186/s13054-019-2596-1. PMID: 31533792; PMCID: PMC6751657.

Wrong comparison

Frat JP, Ricard JD, Quenot JP, Pichon N, Demoule A, Forel JM, Mira JP, Coudroy R, Berquier G, Voisin B, Colin G, Pons B, Danin PE, Devaquet J, Prat G, Clere-Jehl R, Petitpas F, Vivier E, Razazi K, Nay MA, Souday V, Dellamonica J, Argaud L, Ehrmann S, Gibelin A, Girault C, Andreu P, Vignon P, Dangers L, Ragot S, Thille AW; FLORALI-2 study group; REVA network. Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial. Lancet Respir Med. 2019 Apr;7(4):303-312. doi: 10.1016/S2213-2600(19)30048-7. Epub 2019 Mar 18. PMID: 30898520.

Wrong comparison

Guitton C, Ehrmann S, Volteau C, Colin G, Maamar A, Jean-Michel V, Mahe PJ, Landais M, Brule N, Bretonnière C, Zambon O, Vourc'h M. Nasal high-flow preoxygenation for endotracheal intubation in the critically ill patient: a randomized clinical trial. Intensive Care Med. 2019 Apr;45(4):447-458. doi: 10.1007/s00134-019-05529-w. Epub 2019 Jan 21. PMID: 30666367.

Wrong comparison

Holyoak RS, Melhuish TM, Vlok R, Binks M, White LD. Intubation using apnoeic oxygenation to prevent desaturation: A systematic review and meta-analysis. J Crit Care. 2017 Oct;41:42-48. doi: 10.1016/j.jcrc.2017.04.043. Epub 2017 Apr 30. PMID: 28477509.

Original publications used

Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM; Difficult Airway Society; Intensive Care Society; Faculty of Intensive Care Medicine; Royal College of Anaesthetists. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018 Feb;120(2):323-352. doi: 10.1016/j.bja.2017.10.021. Epub 2017 Nov 26. PMID: 29406182.

Wrong study design

Jhou HJ, Chen PH, Lin C, Yang LY, Lee CH, Peng CK. High-flow nasal cannula therapy as apneic oxygenation during endotracheal intubation in critically ill patients in the intensive care unit: a systematic review and meta-analysis. Sci Rep. 2020 Feb 26;10(1):3541. doi: 10.1038/s41598-020-60636-9. PMID: 32103138; PMCID: PMC7044442.

Original publications used

Oliveira J E Silva L, Cabrera D, Barrionuevo P, Johnson RL, Erwin PJ, Murad MH, Bellolio MF. Effectiveness of Apneic Oxygenation During Intubation: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2017 Oct;70(4):483-494.e11. doi: 10.1016/j.annemergmed.2017.05.001. Epub 2017 Jul 14. PMID: 28712606.

Original publications used

Pavlov I, Medrano S, Weingart S. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. Am J Emerg Med. 2017 Aug;35(8):1184-1189. doi: 10.1016/j.ajem.2017.06.029. Epub 2017 Jun 15. PMID: 28647137.

Original publications used

Russotto V, Cortegiani A, Raineri SM, Gregoretti C, Giarratano A. Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis. J Crit Care. 2017 Oct;41:98-106. doi: 10.1016/j.jcrc.2017.05.003. Epub 2017 May 8. PMID: 28505486.

Wrong comparison

Simon M, Wachs C, Braune S, de Heer G, Frings D, Kluge S. High-Flow Nasal Cannula Versus Bag-Valve-Mask for Preoxygenation Before Intubation in Subjects With Hypoxemic Respiratory Failure. Respir Care. 2016 Sep;61(9):1160-7. doi: 10.4187/respcare.04413. Epub 2016 Jun 7. PMID: 27274092.

Wrong comparison

Tan E, Loubani O, Kureshi N, Green RS. Does apneic oxygenation prevent desaturation during emergency airway management? A systematic review and meta-analysis. Can J Anaesth. 2018 Aug;65(8):936-949. English. doi: 10.1007/s12630-018-1124-0. Epub 2018 Apr 23. PMID: 29687359.

Original publications used

Vaughan EM, Seitz KP, Janz DR, Russell DW, Dargin J, Vonderhaar DJ, Joffe AM, West JR, Self WH, Rice TW, Semler MW, Casey JD. Bag-Mask Ventilation Versus Apneic Oxygenation During Tracheal Intubation in Critically Ill Adults: A Secondary Analysis of 2 Randomized Trials. J Intensive Care Med. 2022 Jul;37(7):899-907. doi: 10.1177/08850666211058646. Epub 2021 Dec 13. PMID: 34898310; PMCID: PMC9149042.

Original publications used

Vourc'h M, Asfar P, Volteau C, Bachoumas K, Clavieras N, Egreteau PY, Asehnoune K, Mercat A, Reignier J, Jaber S, Prat G, Roquilly A, Brule N, Villers D, Bretonniere C, Guitton C. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015 Sep;41(9):1538-48. doi: 10.1007/s00134-015-3796-z. Epub 2015 Apr 14. PMID: 25869405.

Wrong comparison

White LD, Vlok RA, Thang CY, Tian DH, Melhuish TM. Oxygenation during the apnoeic phase preceding intubation in adults in prehospital, emergency department, intensive care and operating theatre environments. Cochrane Database Syst Rev. 2023 Aug 2;8(8):CD013558. doi: 10.1002/14651858.CD013558.pub2. PMID: 37531462; PMCID: PMC10419336.

Original publications used