What is a common risk associated with improper positive-pressure ventilation during intubation?

• A. Laryngeal trauma
• B. Gastric insufflation leading to vomiting and aspiration; mitigated by preoxygenation and controlled ventilation.
• C. Hypoxemia from under-ventilation
• D. Pneumothorax

Answer: (B)

When air is delivered under positive pressure while the airway is not yet secured, some of that air can be forced into the stomach instead of reaching the lungs. This gastric insufflation distends the stomach and raises the risk of vomiting and aspiration of gastric contents if regurgitation occurs. This is the classic risk tied to improper positive-pressure ventilation during intubation. The best way to reduce it is through preoxygenation to build a reserve and by ventilating in a controlled manner—using appropriate tidal volumes and airway pressures to minimize air entering the stomach. In high-risk patients, techniques like rapid-sequence induction further lessen the chance of stomach inflation and subsequent aspiration. Other potential issues, such as laryngeal trauma, hypoxemia from under-ventilation, or pneumothorax, can occur with airway management but are not as directly tied to improper PPV during the induction phase as gastric insufflation and aspiration are.