Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials
Abstract
BACKGROUND
Preoxygenation is a crucial preparatory step for intubation. Several strategies for preoxygenation exist, including facemask oxygen, high-flow nasal cannula (HFNC), and non-invasive positive pressure ventilation (NIPPV). However, the comparative efficacy of these strategies remains largely uncertain. We aimed to compare the efficacy and safety of HFNC, NIPPV, and facemask oxygen for preoxygenation of patients who are critically ill requiring tracheal intubation.
METHODS
In this systematic review and network meta-analysis, we searched Embase, MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials for randomised clinical trials published from database inception until Oct 31, 2024, with no language restrictions. We included randomised controlled trials that compared HFNC versus NIPPV, HFNC versus facemask oxygen, or NIPPV versus facemask oxygen in adult patients (age ≥18 years) who were critically ill requiring intubation in the intensive care or emergency department setting. We had no additional eligibility criteria for our network meta-analysis. We used Covidence software to screen eligible trials. Two reviewers independently screened trials for titles and abstracts, and then subsequently screened full-text reports. Discrepancies were resolved by discussion or a third party adjudicator. Summary-level data were extracted manually using a structured data collection form. Outcomes of interest were hypoxaemia during intubation, successful…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,420 participants or records.
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