Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials
Authors' conclusion
Preoxygenation with NIPPV or HFNC rather than facemask oxygen might prevent hypoxaemia during tracheal intubation of adults who are critically ill. Compared with HFNC, NIPPV probably decreases the incidence of hypoxaemia during intubation.
Study context
- Population
- Critically ill adults (≥18 years) requiring intubation in the ICU or ED
- Participants
- 3,420 adults · 15 studies
- Comparison
- Non-invasive positive pressure ventilation (NIPPV) vs high-flow nasal cannula (HFNC) vs facemask oxygen for preoxygenation
- Outcome
- Hypoxaemia during intubation
Methodological detailsfrequentist random-effects network meta-analysis, RoB 2.0, GRADE
- Frequentist random-effects network meta-analysis
- RoB 2.0
- GRADE
Pooled result
As reported in the abstract
Relative risk (95% CI)P value
NIPPV vs HFNCmoderate certainty
0.73(0.55–0.98)
P = 0.032NIPPV vs Facemask oxygenhigh certainty
0.51(0.39–0.65)
P < 0.0001HFNC vs Facemask oxygenhigh certainty
0.69(0.54–0.88)
P = 0.0064Further pooled results
Successful intubation on the first attempt
- Not affected by any preoxygenation strategy (all low certainty)
All-cause mortality
- No strategy appeared to affect all-cause mortality (very low-to-moderate certainty)
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Serious adverse eventsNIPPV vs Facemask oxygen · moderate certainty | 0.30 (0.12–0.77) | P = 0.011 | |
| Serious adverse eventsNIPPV vs HFNC · low certainty | 0.32 (0.11–0.91) | P = 0.035 | |
| Serious adverse eventsHFNC vs Facemask oxygen · low certainty | 0.95 (0.60–1.51) | P = 0.83 | |
| 0.10.31310Relative risk (log scale) |
Original publication
Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials. Lancet Respir Med. Published 21 March 2025. doi:10.
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