C55-23 Effect Modification by Pulmonary Comorbidity: A Secondary Analysis of the PREOXI Trial
Abstract
The PREOXI trial (NEJM 2024) demonstrated that preoxygenation with noninvasive ventilation (NIV) decreased the incidence of hypoxemia during emergency tracheal intubation compared to oxygen mask in critically ill adults. In patients with acute pulmonary insults (API), including pneumonia, shunting and increased dead space may limit the effectiveness of NIV. In contrast, NIV is well-supported for treatment of acute hypercapnic respiratory failure due to obstructive lung disease (OLD). The effectiveness of NIV as a preoxygenation strategy in patients with API or OLD remains uncertain.
We conducted two effect modification (subgroup) analyses of the PREOXI randomized controlled trial evaluating whether (1) the presence of API (defined as pneumonia, aspiration, COVID-19, or ARDS) or (2) chronic OLD (defined as COPD or asthma) modified the effect of preoxygenation with NIV versus oxygen mask. The primary outcome was incidence of hypoxemia during intubation, defined as peripheral oxygen saturation <85% between induction and two minutes after intubation. The secondary outcome was the lowest SpO2 during intubation. Effect modification was assessed by estimating risk differences for the primary outcome within each subgroup and testing interaction terms in generalized linear models. Results are reported as median (IQR) unless otherwise specified.
Among the 1,301 patients enrolled in the PREOXI trial, 316 (24.3%) had an API, and 253 (19.4%) had chronic OLD. In patients with API, the…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,301 participants or records.
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