Apneic Oxygenation, Endotracheal Intubation
Conditions
Keywords
Apneic Oxygenation, Endotracheal intubation, Airway Management, Emergency Department
Brief summary
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.
Interventions
OTHERApneic oxygenation during endotracheal intubation
Providing oxygenation through nasal cannula during the apneic phase of endotracheal intubation.
Sponsors
Rutgers, The State University of New Jersey
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 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).
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Lowest oxygen saturation overall | Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation | Lowest oxygen saturation between overall control and intervention groups |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Need for additional intubating equipment | From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes. | The operator needed to change or add equipment to facilitate intubation |
| Lowest oxygen saturation precipitous intubations | Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation | Lowest oxygen saturation between control and intervention groups that did not receive adequate pre-oxygenation only |
| Lowest oxygen saturation pre-oxygenation | Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation | Lowest oxygen saturation between control and intervention groups that did receive |
| Difference in baseline and final oxygen saturation | Decision to intubate through 2 minutes after completion of endotracheal intubation | — |
| Difference in oxygen saturation before and after apneic period | Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation | — |
| Desaturation | Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation | The proportion of patients who desaturate below 90% |
| Esophageal intubations | From first attempt at intubation through entire ED stay, approximately 6 hours. | The proportion of intubations that resulted in the endotracheal tube being placed in the esophagus |
| Need for second operator | From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes. | A second physician had to attempt intubation |
| Procedural hypotension | Initiation of neuromuscular blockade to 2 minutes after completion of endotracheal intubation | Proportion of became hypotensive at any point during the intubation procedure |
| Aspiration | Within 24 hours after intubation procedure was complete | Proportion of patients that had evidence of aspiration |
| Hospital length of stay | Up to 28 days after intubation | Number of days patient is hospitalized |
| Number of days intubated | Up to 28 days after intubation | — |
| In-hospital mortality | Up to 28 days after intubation | — |
| number of attempts | From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes. | number of times laryngoscope is placed into the mouth in an attempt to pass an endotracheal tube |
Countries
United States
Outcome results
None listed