Abstract

Introduction: Preoxygenation is a cornerstone of safe airway management, aiming to prevent hypoxemia during the apnoea associated with intubation. Efforts to optimize preoxygenation have led to the exploration of alternative techniques, such as non-invasive ventilation (NIV). The Bain circuit, a low-resistance modification of the Mapleson D system, is commonly utilized for its effcient gas delivery to support both spontaneous and controlled ventilation. Settings and Design: Prospective observational study. Methods and Materials: The aim was to compare the effectiveness of the Bain circuit versus NIV in preoxygenation to prevent peri-intubation hypoxemia. A prospective study was conducted among 40 subjects (20 in each of the NIV and Bain circuit groups) who were 18 years of age or older. Pregnant patients and those with diffculty in the airways, hemodynamic instability, and facial trauma were excluded. The lowest SpO2 level achieved, the time to desaturation (SpO2 < 90%), and the incidence of hypoxemia and adverse outcomes were noted in both groups and compared. Results: The lowest SpO2 level achieved was 88.0% and 83.0% in NIV and Bain circuit groups respectively (p <0.049). Incidence of hypoxemia was higher in the Bain circuit group than the NIV group (15.0% v 5.0%; p <0.049). Time to desaturation during intubation was found to be higher in the Bain circuit group. Two patients (10.0%) in the Bain circuit group and one patient (5.0%) in the NIV group developed aspiration pneumonitis during intubation. Conclusions: Among adults undergoing tracheal intubation, preoxygenation with NIV resulted in a lower incidence of hypoxemia during intubation than preoxygenation with the Bain circuit.

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