Referenced below are three of the better articles on this subject, which provide fairly convincing evidence that in hypoxic patients (PNA, ARDS, etc.), a few minutes on NIV prior to intubation will get you a higher starting saturation, safer apnea time, and much less of a drastic desaturation during the attempt. I invite our providers and RTs to be familiar with this concept so that we have it as an option in the right patients if the airway doc is inclined to use it.
My practice is to wheel the vent to the bedside, set it to Spontaneous/Pressure Support 5 over 5, FiO2 of 100%, back-up rate of nothing (4 or 6, something very low so there is no asynchrony), hook the hose up to a NIV mask and place on the patient for a few minutes while I set up for the airway. Then after drugs are pushed, I hold the NIV mask over the mouth with a jaw thrust, let the patient take their last few breaths, and then hold the mask there for 45-60 seconds while the drugs kick in (NOT giving any breaths—still technically an RSI). This keeps the patient PEEPed open and maintains an O2 gradient flowing from circuit to alveoli. Then I pop the mask off, intubate, and hook the circuit up to the tube with an ETCO2 detector, and start them on lung-protective settings right away.
