Related Experiment Video
Updated: Sep 19, 2026
Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
Efficacy and Safety of Ventilator Assisted Preoxygenation for Intubation in Two Australian Emergency Departments: A
Amy Lee1, Victoria Varley2, Christopher Davis2
1Logan Hospital, Metro South Health, Loganlea, Queensland, Australia.
Objective:
This study describes the incidence of first-pass intubation without hypoxaemia in patients who underwent endotracheal intubation using ventilator assisted preoxygenation (VAPOX).
Methods:
Retrospective cohort study of adult patients who underwent VAPOX assisted endotracheal intubation between February 2021 and June 2025 in two EDs. The primary outcome was intubation with first-pass success (FPS) without hypoxaemia (SpO2 < 90%). Secondary outcomes included FPS, adverse events (hypoxia, hypotension, aspiration) and oxygenation trajectories (SpO2 and FiO2) pre- and post-intubation.
Results:
Of the 116 patients who received VAPOX, 78% (90/116; 95% CI 69%-84%) had FPS without hypoxaemia. Overall FPS occurred in 91% (105/116; 95% CI 84%-95%). Hypoxaemia (SpO2 < 90%) occurred in 17% (20/116; 95% CI 11%-25%), including 11% (13/116; 95% CI 7%-18%) with severe hypoxaemia (SpO2< 85%) and 6% (7/116; 95% CI 3%-12%) with critical hypoxaemia (SpO2< 80%). Half of all patients experienced at least one complication (58/116; 50%, 95% CI 41%-59%). Post-intubation hypotension (systolic blood pressure [SBP] < 90 mmHg) occurred in 36% of patients. No reported incidences of aspiration. Respiratory failure was the most common indication for intubation (60%) and was independently associated with a lower likelihood of success (OR 0.14; 95% CI 0.04-0.52).
Conclusions:
We describe a cohort of patients who received VAPOX assisted ED intubation with a FPS without hypoxaemia of 78%. This was a critically ill cohort, with 46% of patients having oxygen saturations < 90% in the hour prior to intubation. These findings provide a benchmark for ED intubation using VAPOX and a comparison for future research.
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