R.E.B.E.L.EM - March 21, 2019 - By Anand Swaminathan
"Authors Conclusions: “Among critically ill adults undergoing tracheal intubation, patients receiving bagmask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation.”
Our Conclusions: The use of BMV after induction resulted in improved oxygen saturation with a lower incidence of severe hypoxemia in comparison to no BMV in the ICU. However, there were some important limitations that may overstate the benefit including underlying pathophysiology, pre-oxygenation and apneic oxygenation approach.
Potential to Impact Current Practice: This study should not result in widespread adoption of BMV after induction of the critically ill patient. However, its use should be considered in patients where clinicians perceive there to be inadequate oxygenation due to shunting and where regurgitation risk isn’t increased. Use of BMV must be properly taught to avoid aggressive, high-volume BMV which will likely insulate the stomach leading to regurgitation.
Bottom Line: Though it is unlikely to be necessary in all cases of intubation of critically ill patients, BMV can be considered on a case by case basis and may be particularly useful in patients who are unable to reach appropriate pre-oxygenation (> 95%) despite non-rebreather and nasal cannula at > 15 L."