Preoxygenation With and Without Positive End-Expiratory Pressure in Lung-Healthy Volunteers: A Randomized Clinical Trial
Authors' conclusion
In this crossover randomized clinical trial, preoxygenation with PEEP was more effective than preoxygenation without PEEP, resulting in higher Feo2 values and improved ventilation in dependent lung regions.
Study context
- Population
- Lung-healthy volunteers: adults with normal weight (NW), adults with overweight or obesity (OW-OB), and children aged 6 to 12 years; Eurac Research, Bolzano, Italy, May 202416 NW, 18 OW-OB, 19 children
- Participants
- 53 volunteers
- Comparison
- Bag-valve mask (BVM) and BVM plus PEEP vs nonrebreather mask for preoxygenation
- Primary endpoint
- Expiratory oxygen concentration (Feo2)
- Follow-up
- End of preoxygenation
Methodological detailscrossover
- Crossover
Primary result
As reported in the abstract
Feo2 at end of preoxygenation (subgroups)
BVM and BVM plus PEEP vs NRM: P < 0.001 · BVM and BVM plus PEEP vs NRM: P < 0.001 · BVM and BVM plus PEEP vs NRM: P < 0.001
Secondary outcomes
Mean
| Outcome | NRM | BVM plus PEEP | P value |
|---|---|---|---|
| Ventilation in dependent lung regions (electrical impedance tomography)Adults with NW | P = 0.03 | ||
| Ventilation in dependent lung regions (electrical impedance tomography)Children | P = 0.002 | ||
| Oxygenation reserve index (ORI), adults with OW-OB · end of preoxygenationBVM plus PEEP vs NRM | 0.73 (SD 0.13) | 0.79 (SD 0.13) | P < 0.001 |
| Time for ORI to return to baselineAdults with OW-OB | P = 0.01 | ||
| Time for ORI to return to baselineChildren | P < 0.001 |
- Ventilation in dependent lung regions (electrical impedance tomography): BVM plus PEEP (adults NW) mean 51.9 (SD 9.3)
- Ventilation in dependent lung regions (electrical impedance tomography): NRM (adults NW) mean 47.0 (SD 5.7)
- Ventilation in dependent lung regions (electrical impedance tomography): BVM plus PEEP (children) mean 53.0 (SD 7.3)
- Ventilation in dependent lung regions (electrical impedance tomography): NRM (children) mean 47.7 (SD 7.0)
- Time for ORI to return to baseline: BVM plus PEEP (adults OW-OB) mean 196 (SE 74) seconds
- Time for ORI to return to baseline: NRM (adults OW-OB) mean 158 (SE 53) seconds
- Time for ORI to return to baseline: BVM plus PEEP (children) mean 115 (SE 59) seconds
- Time for ORI to return to baseline: NRM (children) mean 62 (SE 36) seconds
Original publication
Preoxygenation With and Without Positive End-Expiratory Pressure in Lung-Healthy Volunteers: A Randomized Clinical Trial. JAMA Netw Open. Published 1 May 2025. doi:10.
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