Trial Outcomes & Findings for Pragmatic Trial Examining Oxygenation Prior to Intubation (NCT NCT05267652)

NCT ID: NCT05267652

Last Updated: 2024-12-09

Results Overview

A peripheral oxygen saturation \< 85% during the interval between induction and 2 minutes after tracheal intubation

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

1301 participants

Primary outcome timeframe

from induction to 2 minutes following tracheal intubation

Results posted on

2024-12-09

Participant Flow

Participant milestones

Participant milestones
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Overall Study
STARTED
645
656
Overall Study
COMPLETED
645
656
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Pragmatic Trial Examining Oxygenation Prior to Intubation

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Total
n=1301 Participants
Total of all reporting groups
Region of Enrollment
United States
645 participants
n=5 Participants
656 participants
n=7 Participants
1301 participants
n=5 Participants
Age, Continuous
61 years
n=5 Participants
61 years
n=7 Participants
61 years
n=5 Participants
Sex: Female, Male
Female
255 Participants
n=5 Participants
260 Participants
n=7 Participants
515 Participants
n=5 Participants
Sex: Female, Male
Male
390 Participants
n=5 Participants
396 Participants
n=7 Participants
786 Participants
n=5 Participants
Race/Ethnicity, Customized
Non-Hispanic White
384 Participants
n=5 Participants
399 Participants
n=7 Participants
783 Participants
n=5 Participants
Race/Ethnicity, Customized
Non-Hispanic Black
124 Participants
n=5 Participants
152 Participants
n=7 Participants
276 Participants
n=5 Participants
Race/Ethnicity, Customized
Hispanic
80 Participants
n=5 Participants
63 Participants
n=7 Participants
143 Participants
n=5 Participants
Race/Ethnicity, Customized
Other
48 Participants
n=5 Participants
36 Participants
n=7 Participants
84 Participants
n=5 Participants
Race/Ethnicity, Customized
Not Reported
9 Participants
n=5 Participants
6 Participants
n=7 Participants
15 Participants
n=5 Participants

PRIMARY outcome

Timeframe: from induction to 2 minutes following tracheal intubation

A peripheral oxygen saturation \< 85% during the interval between induction and 2 minutes after tracheal intubation

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=624 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=637 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of Hypoxemia
57 Participants
118 Participants

SECONDARY outcome

Timeframe: from induction to 2 minutes following tracheal intubation

Lowest oxygen saturation during the interval between induction and 2 minutes after tracheal intubation

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=624 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=637 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Lowest Oxygen Saturation
99 Oxygen Saturation (%)
Interval 95.0 to 100.0
97 Oxygen Saturation (%)
Interval 89.0 to 100.0

OTHER_PRE_SPECIFIED outcome

Timeframe: from induction to 2 minutes following tracheal intubation

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of Operator-reported Aspiration
6 Participants
9 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: 24 hours after induction

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=590 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=594 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Fraction of Inspired Oxygen at 24 Hours After Induction
40 Percentage
Interval 30.0 to 40.0
40 Percentage
Interval 30.0 to 40.0

OTHER_PRE_SPECIFIED outcome

Timeframe: 24 hours after induction

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=589 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=594 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Oxygen Saturation at 24 Hours After Induction
97 Oxygen Saturation (%)
Interval 95.0 to 100.0
97 Oxygen Saturation (%)
Interval 95.0 to 100.0

OTHER_PRE_SPECIFIED outcome

Timeframe: from induction to 24 hours after induction

Radiology report of new pneumothorax on chest x-ray in the 24 hours after induction

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=509 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=497 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of Pneumothorax
7 Participants
7 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: from induction to 24 hours after induction

Radiology report of new infiltrate on chest imaging in the 24 hours after intubation

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=509 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=497 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of New Infiltrate
144 Participants
148 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: from induction to 2 minutes following tracheal intubation

Lowest oxygen saturation of \<80% between induction and two minutes after tracheal intubation

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=624 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=637 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of Severe Hypoxemia
39 Participants
84 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: from induction to 2 minutes following tracheal intubation

Lowest oxygen saturation of \<70% between induction and two minutes after tracheal intubation

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=624 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=637 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of Very Severe Hypoxemia
15 Participants
36 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: from enrollment to induction

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=625 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=643 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Oxygen Saturation at Induction
100 Oxygen Saturation (%)
Interval 99.0 to 100.0
100 Oxygen Saturation (%)
Interval 97.0 to 100.0

OTHER_PRE_SPECIFIED outcome

Timeframe: from enrollment to induction

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=619 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=632 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Systolic Blood Pressure at Induction
124 mmHg
Interval 107.0 to 143.0
129 mmHg
Interval 111.0 to 148.0

OTHER_PRE_SPECIFIED outcome

Timeframe: Duration of procedure (minutes)

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Duration From Induction to Successful Intubation
115 Seconds
Interval 89.0 to 150.0
113 Seconds
Interval 85.0 to 152.0

OTHER_PRE_SPECIFIED outcome

Timeframe: Duration of procedure (minutes)

Grade 1: Full view of glottis Grade 2: Partial view of glottis Grade 3: Only epiglottis seen (none of glottis) Grade 4: Neither glottis nor epiglottis seen

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=655 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Cormack-Lehane Grade of Glottic View on First Attempt
Grade 1
434 Participants
456 Participants
Cormack-Lehane Grade of Glottic View on First Attempt
Grade 2
165 Participants
148 Participants
Cormack-Lehane Grade of Glottic View on First Attempt
Grade 3
29 Participants
36 Participants
Cormack-Lehane Grade of Glottic View on First Attempt
Grade 4
17 Participants
15 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: Duration of procedure (minutes)

Placement of an endotracheal tube in the trachea with a single insertion of a laryngoscope blade into the mouth and either a single insertion of an endotracheal tube into the mouth or a single insertion of a bougie into the mouth followed by a single insertion of an endotracheal tube into the mouth

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of Successful Intubation on the First Attempt
534 Participants
535 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: Duration of procedure (minutes)

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=641 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=654 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Number of Laryngoscopy Attempts
1 attempts
Interval 1.0 to 1.0
1 attempts
Interval 1.0 to 1.0

OTHER_PRE_SPECIFIED outcome

Timeframe: Duration of procedure (minutes)

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=641 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=655 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Number of Attempts at Passing a Bougie
0 attempts
Interval 0.0 to 1.0
0 attempts
Interval 0.0 to 1.0

OTHER_PRE_SPECIFIED outcome

Timeframe: Duration of procedure (minutes)

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=641 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=654 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Number of Attempts at Passing an Endotracheal Tube
1 attempts
Interval 1.0 to 1.0
1 attempts
Interval 1.0 to 1.0

OTHER_PRE_SPECIFIED outcome

Timeframe: from induction to 2 minutes following tracheal intubation

A composite of one or more of the following between induction and 2 minutes after intubation: * Systolic blood pressure \< 65 mmHg * New or increased vasopressor * Cardiac arrest not resulting in death within 1 hour of induction * Cardiac arrest resulting in death within 1 hour of induction

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Incidence of Cardiovascular Collapse
113 Participants
127 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: 28 days

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
28-day In-hospital Mortality
209 Participants
217 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: 28 days

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Ventilator-free Days to 28 Days
21 Days
Interval 0.0 to 26.0
17 Days
Interval 0.0 to 25.0

OTHER_PRE_SPECIFIED outcome

Timeframe: 28 days

Outcome measures

Outcome measures
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 Participants
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 Participants
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
ICU-free Days to 28 Days
16 Days
Interval 0.0 to 23.0
14 Days
Interval 0.0 to 23.0

Adverse Events

Preoxygenation With Non-Invasive Positive Pressure Ventilation Group

Serious events: 2 serious events
Other events: 0 other events
Deaths: 209 deaths

Preoxygenation With Facemask Oxygen Group

Serious events: 0 serious events
Other events: 0 other events
Deaths: 217 deaths

Serious adverse events

Serious adverse events
Measure
Preoxygenation With Non-Invasive Positive Pressure Ventilation Group
n=645 participants at risk
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. Preoxygenation with Non-Invasive Positive Pressure Ventilation: The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
Preoxygenation With Facemask Oxygen Group
n=656 participants at risk
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. Facemask Oxygen: The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
Surgical and medical procedures
Aspiration
0.31%
2/645 • Number of events 2 • Adverse events were collected from enrollment to 28 days after enrollment.
Because this trial compared strategies commonly used in routine clinical care, the only events that were recorded or reported as adverse events were those that were related to the study and serious or unexpected. Critically ill adults who require tracheal intubation are at risk for hypoxemia, hypotension, cardiac arrest, and death. These events were recorded as study outcomes and only recorded as AEs if related to the study intervention, which was expected to be rare.
0.00%
0/656 • Adverse events were collected from enrollment to 28 days after enrollment.
Because this trial compared strategies commonly used in routine clinical care, the only events that were recorded or reported as adverse events were those that were related to the study and serious or unexpected. Critically ill adults who require tracheal intubation are at risk for hypoxemia, hypotension, cardiac arrest, and death. These events were recorded as study outcomes and only recorded as AEs if related to the study intervention, which was expected to be rare.

Other adverse events

Adverse event data not reported

Additional Information

Jonathan D Casey, MD, MSc

Vanderbilt University Medical Center

Phone: 615-875-4681

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place