Non-Invasive Ventilation as a Pre-Oxygenation Strategy During In-Flight Rapid Sequence Intubation: A Case Report

Noninvasive ventilation has been used as a pre-oxygenation strategy for rapid sequence intubation in the emergency department and the intensive care unit, yet, limited research has examined its use in the transport setting. These case reports discuss the use of noninvasive ventilation via a Hamilton T1 ventilator (Hamilton Medical) during transport by an air medical crew for pre-oxygenation before intubation in two cases. In both cases, a noninvasive, bilevel-positive airway pressure mode with a backup rate was used to achieve adequate airway pressures while allowing for a two-handed seal by one emergency medical services clinician as the other prepared the equipment and medications. This method of pre-oxygenation in a space and resource-limited setting was associated with first-pass success without hypoxia in both cases. This adds another method of pre-oxygenation to facilitate safe intubation in similar settings.