Effectiveness of noninvasive ventilation for preoxygenation in emergency intubation: a systematic review and meta-analysis

OBJECTIVE: To evaluate the impact of noninvasive ventilation versus bag-valve-mask ventilation preoxygenation on safety and efficacy outcomes. METHODS: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials that compared preoxygenation using noninvasive ventilation and bag-valve-mask ventilation. The reported outcomes were all-cause mortality; hypoxemia during intubation; and regurgitation. We perform frequentist and Bayesian analysis. Heterogeneity was examined with I2 statistics. Statistical analysis was done using RStudio and Review Manager. RESULTS: We included 3 randomized controlled trials with 1,555 patients, of whom 771 (49.6%) received preoxygenation with noninvasive ventilation (intervention group). Hypoxemia during intubation was significantly lower in the noninvasive ventilation compared to the bag-valve-mask ventilation group in frequentist with a pooled log RR of -0.94 (log RR -0.94; 95%CI -1.61 - -0.28) and Bayesian pooled log risk ratio of -0.32 (log RR -0.32; 95% credible interval -0.91 - 0.40). Regurgitation was a safety outcome that did not present a difference between the groups in the frequentist or Bayesian models, with log RR -0.50 (log RR -0.50; 95% credible interval -2.09 - 1.01). There was no significant difference between groups in all-cause mortality and other secondary outcomes. CONCLUSION: Preoxygenation with noninvasive ventilation significantly reduces the risk of hypoxemia during emergency intubation compared to bag-valve-mask ventilation. However, there were no significant differences in all-cause mortality or regurgitation rates.