Helping patients to breathe during a dangerous procedure avoids complications

Thousands of Americans die every year during a dangerous two minute procedure to insert a breathing tube.

Currently, a study of the Vanderbilt University Medical Center (VUMC) in the New England Journal of Medicine (NEJM) shows that through ventilation with a face mask, squeezing air from a bag into the mouth for 60 seconds to help patients breathe better, improve results and potentially save lives.

"When you put in a breathing tube, you have to give patients medications that make them feel relaxed and sleepy, and these drugs take about a minute to work," said lead author Jonathan D. Casey, MD, an intensive care fellow. pulmonary VUMC.

"Once you've administered these medications, doctors are questioning a lot about the opportunity to wait and watch as their breathing slows down or stop, or provide a breakdown." (breathing for the patient) with a protective mask device.We have found that with a bag-mask is safe and very effective.More importantly, it halves the rate of oxygen extremely low. "

Tracheal intubation, the process of setting up a respiratory tube, may be necessary to perform surgery or to support breathing during a serious illness. During tracheal intubation for disease, about 40% of people suffer from lack of oxygen, which can cause brain and heart damage, and 2% of people in cardiac arrest, a sudden failure of the often fatal cardiac function.

The PreVent trial (Prevention of manual ventilation hypoxemia during endotracheal intubation) is a multicenter trial of ventilation using a pocket mask during tracheal intubation. the results, published today in the NEJM, have the potential to change practices across the country, as more than 1.5 million patients experience tracheal intubation each year in the United States.

"Doctors have been practicing this procedure for 50 years and the safest way to do it has always been controversial," Casey said. "Some doctors think that when you squeeze the bag and force the air into the lungs, the air also enters the stomach and exposes the patient to the risk of vomiting the contents of the stomach. stomach in the lungs.

"This is not what we found.Our study found that ventilation by means of a safety mask did not cause the vomiting that worried people and that it was very effective for prevent low levels of oxygen. "

The multi-center trial was conducted in seven USIs across the United States, with adult patients undergoing intervention with pocket mask ventilation or non-ventilation between induction and laryngoscopy.

Among the 401 patients enrolled, the lowest median oxygen saturation was 96% in the pocket mask ventilation group, compared to 93% in the non-ventilated group.

A total of 21 patients in the pocket mask ventilation group had extremely low oxygen levels, compared with 45 patients in the no ventilation group.

Vomiting of stomach contents in the lungs occurred during 2.5% of intubations in the mask ventilation group and in 4% of cases without mask ventilation.

Vanderbilt's medical UTI now routinely uses ventilation with a protective mask when placing a breathing tube.

"It's important to act based on what we've learned, not only have we immediately applied these important results to our practice, but we have also undertaken follow-up testing on other ways of doing so." 39, improve the safety of tracheal intubation – and these new trials require this bag – mask ventilation is provided to each patient receiving a breathing tube, "said Matthew W. Semler, MD, MSc, badociate director of Intensive Care Unit at Vanderbilt and lead author of the study.

"The best thing about this intervention is that it's free," concluded David R. Janz, MD, MSc, an badistant professor of medicine at Louisiana State University and co-author of the essay. "This is a device that is already available when you install a breathing tube.First, we used the mask device to help patients breathe better than if we had difficulty setting up a breathing tube. in each procedure even before we make our first attempt to set up a breathing tube. "

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The study was funded by the Vanderbilt Institute for Clinical and Translational Research; Prevent ClinicalTrials.gov number NCT03026322.

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