Huge practice change: BiPAP for preoxygenation (The PREOXI trial)

[@karenbocek-steele2219]

Love your content. I'm a CCRN and currently working in the ED. I appreciate your clinical perspective and evidence based approach. Keep up the good work!

[@singingsam40]

I think that bipap is a game-changer in a lot of ways. I have severe eosinophillic asthma and have been intubated and ventilated more times than I can count. But, in 2019, I was diagnosed as having type 2 respiratory failure and given a bipap to use at home at night. Realising how effective this machine is, I started showing the doctors some notes I wrote where I suggest trying bipap first before intubating. I haven't been intubated in a life-threatening attack since. That machine has changed my life. (Just for context, I used to be a nurse, so have an interest in medicine already.)

[@michaelscott33]

This is one of those “studies” that really didn’t need to be studied in order to know that it should be done. There were limitations in that if the positive pressure non-invasive ventilation wasn’t readily available ar bedside, then it wasn’t used. Which leads me to my point - any institution that has readily available NIPPV equipment and resources is already doing these practices in the peri-intubation setting. It’s common sense. If NIPPV is available within a reasonable amount of time, then I use it 100% of the time in that situation. I don’t really understand why we needed a study to prove that NIPPV is superior to no oxygen or basic non-positive pressure methods. This study reminds me of the other study in the Peri-arrest setting where they compared manual palpation of the femoral artery versus Ultrasound Doppler wave technology to assess perfusion during CPR and detecting thready pulses. We don’t need a study to show that an ultrasound is superior to manually palpating the groin to asses for femoral artery pulsation…. Bottom line, this isn’t “practice changing,” because if it is..then, you’ve been practicing bad medicine.

[@Camboo10]

I concur with this practice and have been using something similar for awile now. The only adjustment that I make is because I am at higher elevation all my numbers are shifted a bit when useing pulse ox. This is something that I dont this is discussed much how elevation may change practice but may be worth looking into a standard for higher elevations.

[@michaelscott33]

There are already studies that have looked into this. At the end of the day, it doesn’t change the practice.