Critical Illness
Conditions
Keywords
Rapid Sequence Intubation, Emergency Department, Bispectral Index, Hemodynamic Response
Brief summary
Rapid sequence intubation (RSI) is the standard approach for emergency airway management in critically ill patients requiring endotracheal intubation. Laryngoscopy and tracheal intubation may provoke significant hemodynamic responses, including increases in heart rate and blood pressure, which may adversely affect patients with severe neurological or cardiovascular disease. Although hemodynamic responses during tracheal intubation have been extensively investigated in the anesthesiology literature, evidence from emergency department settings remains limited. Furthermore, previous studies have rarely confirmed whether an adequate depth of anesthesia had been achieved before laryngoscopy, making interpretation of hemodynamic responses difficult. The aim of this prospective observational study is to evaluate hemodynamic responses during rapid sequence intubation in adult emergency department patients after confirming adequate depth of anesthesia using bispectral index (BIS) monitoring. Heart rate and blood pressure will be recorded before induction, during intubation, and after successful endotracheal intubation, allowing objective assessment of the hemodynamic response under confirmed adequate anesthetic depth.
Detailed description
Rapid sequence intubation (RSI) is the standard approach for emergency airway management in critically ill patients requiring endotracheal intubation. Laryngoscopy and tracheal intubation may provoke significant hemodynamic responses, including increases in heart rate and blood pressure, which may adversely affect patients with severe neurological or cardiovascular disease. Although hemodynamic responses during tracheal intubation have been extensively investigated in the anesthesiology literature, evidence from emergency department settings remains limited. Furthermore, previous studies have rarely confirmed whether an adequate depth of anesthesia had been achieved before laryngoscopy, making interpretation of hemodynamic responses difficult. The aim of this prospective observational study is to evaluate hemodynamic responses during rapid sequence intubation in adult emergency department patients after confirming adequate depth of anesthesia using bispectral index (BIS) monitoring. Heart rate and blood pressure will be recorded before induction, during intubation, and after successful endotracheal intubation, allowing objective assessment of the hemodynamic response under confirmed adequate anesthetic depth.
Interventions
Bispectral index monitoring is used to assess the depth of anesthesia before laryngoscopy. Endotracheal intubation is performed after an adequate BIS value has been achieved.
Sponsors
Akdeniz University Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults aged 18 years or older. Patients undergoing rapid sequence intubation (RSI) in the emergency department. Patients in whom bispectral index (BIS) monitoring can be applied before laryngoscopy. Patients achieving an adequate depth of anesthesia (BIS 45-55) before laryngoscopy. Written informed consent obtained from the patient or a legally authorized representative, when applicable according to local ethics requirements.
Exclusion criteria
Age \<18 years. Cardiac arrest before or during induction. Patients requiring immediate ("crash") intubation without sufficient time for BIS monitoring. Inability to obtain reliable BIS monitoring (e.g., technical failure or inability to place the sensor). Pregnancy. Facial or scalp conditions preventing BIS sensor placement. Prisoners or other vulnerable populations if excluded by the ethics protocol. \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Diastolic Blood Pressure Following Rapid Sequence Intubation | Baseline, immediately after intubation, and 5, 10, and 15 minutes after intubation | Diastolic Blood pressure (MAP) measured before induction, immediately after endotracheal intubation, and at 5, 10, and 15 minutes after intubation in patients with BIS-confirmed adequate depth of anesthesia. |
| Change in Systolic Blood Pressure Following Rapid Sequence Intubation | Baseline, immediately after intubation, and 5, 10, and 15 minutes after intubation | Systolic Blood pressure measured before induction, immediately after endotracheal intubation, and at 5, 10, and 15 minutes after intubation in patients with BIS-confirmed adequate depth of anesthesia. |
| Change in Heart Rate Following Rapid Sequence Intubation | Baseline, immediately after intubation, and 5, 10, and 15 minutes after intubation | Heart Rate measured before induction, immediately after endotracheal intubation, and at 5, 10, and 15 minutes after intubation in patients with BIS-confirmed adequate depth of anesthesia. |
Countries
Turkey (Türkiye)
Contacts
CONTACTErkan Göksu, MD
Outcome results
None listed