Randomized Controlled Trial of Apneic Oxygenation Including Precipitous Intubations During RSI in the Emergency Department
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 10
- 试验地点
- 2
- 主要终点
- Lowest oxygen saturation overall
研究概览
简要总结
This RCT is testing the efficacy of apneic oxygenation during endotracheal intubation in the emergency department. Currently the standard practice in the ED when performing endotracheal intubation is that some providers use apneic oxygenation (the application of a nasal cannula at 15LPM) throughout the intubation procedure, while others do not apply apneic oxygenation. Initial literature in the operating room showed that apneic oxygenation helps prevent desaturation during the procedure. However, the latest literature conducted in critical care settings (one study in the ICU and one in the ED) questions the efficacy of this intervention in critically ill patients; however, no harm has been shown. Our study aims to test this intervention further by adding in a special subset of patients that was excluded from prior studies, precipitous intubations, or those patients that have to be intubated quickly and cannot have adequate pre-oxygenation. We hypothesize that apneic oxygenation will be more efficacious in this subset than in the overall ED population. We will randomize patients requiring endotracheal intubation into intervention (apneic oxygenation) and control (no apneic oxygenation). We will measure the lowest arterial oxygen saturation from the start of the intubation procedure through 2 minutes after intubation is complete.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The inclusion criteria for our study will include patients 18 years or older who require emergent endotracheal intubation utilizing rapid sequence intubation (RSI) in the Emergency Department with first attempt taken by a resident or attending physician working in the emergency department. This includes Emergency Medicine attending physicians and residents as well as non-Emergency Medicine rotators (e.g.., Internal Medicine residents who are rotating through the Emergency Department).
排除标准
- •Exclusion criteria include patients who are in cardiac arrest, or if the patient received any positive pressure ventilation (i.e, BPAP, CPAP, BVM) in the emergency department before RSI.
结局指标
主要结局
Lowest oxygen saturation overall
时间窗: Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation
Lowest oxygen saturation between overall control and intervention groups
次要结局
- Difference in baseline and final oxygen saturation(Decision to intubate through 2 minutes after completion of endotracheal intubation)
- Desaturation(Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation)
- Hospital length of stay(Up to 28 days after intubation)
- Number of days intubated(Up to 28 days after intubation)
- Lowest oxygen saturation precipitous intubations(Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation)
- Need for second operator(From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes.)
- In-hospital mortality(Up to 28 days after intubation)
- Difference in oxygen saturation before and after apneic period(Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation)
- Procedural hypotension(Initiation of neuromuscular blockade to 2 minutes after completion of endotracheal intubation)
- Need for additional intubating equipment(From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes.)
- Aspiration(Within 24 hours after intubation procedure was complete)
- Lowest oxygen saturation pre-oxygenation(Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation)
- number of attempts(From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes.)
- Esophageal intubations(From first attempt at intubation through entire ED stay, approximately 6 hours.)
研究者
Ilya Ostrovsky, MD
Assistant Professor of Emergency Medicine
Rutgers, The State University of New Jersey