Admon (2019)

Hypoxemia

Intensive care • Rcts Data • US

View Paper Protocol

Study Metrics

Total Sample 360

Treatment Group 180

Control Group 180

Covariates 11

PICO Comparisons 10

Quality Indicators

Transparency High

DAG Usage No

QBA Performed No

Study Information

First Author:	Admon
Publication Year:	2019
DOI:	https://doi.org/10.1513/AnnalsATS.201903-241OC
Preprint:	No preprint

Institution & Funding

Institution Type:	Academic
Institutions:	University of Michigan, Veterans Affairs Center, Vanderbilt University Medical Center, Louisiana State University School of Medicine, University of Alabama at Birmingham, University of Washington, Ochsner Health System New Orleans, Lahey Hospital and Medical Center
Funding:	Declared: Public
Funding Institutions:	U.S. National Heart, Lung, and Blood Institute grants T32HL007749 (A.J.A.), K12HL138039 (J.P.D.), T32HL087738 (J.D.C.), and K23HL143053 (M.W.S.), and by U.S. Department of Veterans Affairs Health Services Research and Development grant 17-045 (T.J.I.).

Study Context

Disease:	Hypoxemia
Disease Category:	Intensive care
Data Type:	rcts
Number of Data Sources:	3

Geography:	US
Eligible Sample:	360.0
Number of Treatments:	2

Analytical Methods

Missing Data Method:	Multiple imputation
Matching Method:	PS matching
Analysis Method:	linear regression

Quality Methods

Directed Acyclic Graph (DAG) Not Used

Quantitative Bias Analysis (QBA) Not Performed

Target Trial Information

Target Trial Name:	PreVent
Registration Number:	NCT03026322
Target Trial DOI:	https://doi.org/10.1056/NEJMoa1812405

TTE vs RCT Comparisons

Detailed comparison between Target Trial Emulation results and corresponding Randomized Controlled Trial outcomes.

Cardiac arrest 1 h after intubation

PreVent

RR Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

Cardiac arrest 1 h after intubation

RCT Result

2.00

95% CI: [0.40, 10.80]

TTE Result

0.76

95% CI: [0.20, 3.40]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Different Direction
Different conclusions

Decrease in oxygen saturation %

PreVent

MD Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

Decrease in oxygen saturation %

RCT Result

-1.90

95% CI: [-4.50, 0.80]

TTE Result

-4.50

95% CI: [-6.80, -2.20]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

Died before hospital discharge

PreVent

RR Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

Died before hospital discharge

RCT Result

1.00

95% CI: [0.80, 1.30]

TTE Result

1.00

95% CI: [0.80, 1.30]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

ICU-free days

PreVent

MD Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

ICU-free days

RCT Result

0.10

95% CI: [-2.20, 2.40]

TTE Result

0.80

95% CI: [-1.30, 2.90]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

lowest oxygen saturation %

PreVent

MD Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

lowest oxygen saturation %

RCT Result

3.90

95% CI: [1.40, 6.40]

TTE Result

1.80

95% CI: [-1.00, 4.60]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

lowest oxygen saturation <70%

PreVent

RR Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

lowest oxygen saturation <70%

RCT Result

0.63

95% CI: [0.30, 1.30]

TTE Result

0.41

95% CI: [0.20, 0.90]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

lowest oxygen saturation <80%

PreVent

RR Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

lowest oxygen saturation <80%

RCT Result

0.48

95% CI: [0.30, 0.77]

TTE Result

0.60

95% CI: [0.38, 0.93]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

lowest oxygen saturation <90%

PreVent

RR Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

lowest oxygen saturation <90%

RCT Result

0.74

95% CI: [0.60, 1.00]

TTE Result

0.89

95% CI: [0.70, 1.20]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

Operator-reported aspiration

PreVent

RR Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

Operator-reported aspiration

RCT Result

3.00

95% CI: [0.40, 10.80]

TTE Result

0.64

95% CI: [0.20, 1.90]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Different Direction
Different conclusions

Ventilator-free days

PreVent

MD Efficacy

Population

patients undergoing tracheal intubation

Intervention

positive-pressure ventilation with a bag- mask device or noninvasive ventilator (modi ed RSI)

Comparison

No positive-pressure ventilation except after a failed attempt or for SpO2 ,90% (classic RSI)

Outcome

Ventilator-free days

RCT Result

-0.50

95% CI: [-3.00, 1.90]

TTE Result

0.60

95% CI: [-1.70, 2.90]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Different Direction
Different conclusions

Transparency Indicators

Protocol Registration Available

Data Sharing Not Available

Code Sharing Not Available

Overall Transparency Score:

High Transparency - This study meets good transparency standards.

Conflicts & Funding

Conflicts of Interest:	Declared: None
Funding Source:	Declared: Public
Funding Institutions:	U.S. National Heart, Lung, and Blood Institute grants T32HL007749 (A.J.A.), K12HL138039 (J.P.D.), T32HL087738 (J.D.C.), and K23HL143053 (M.W.S.), and by U.S. Department of Veterans Affairs Health Services Research and Development grant 17-045 (T.J.I.).

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