Checklists and Upright Positioning in Endotracheal Intubation of Critically Ill Patients (Check-UP) Trial

Vanderbilt University260 enrolled

Overview

The use of a written, pre-procedure checklist and positioning the patient with the head of the bed elevated have been proposed as interventions capable of preventing complications during non-elective intubation and are used intermittently in routine care -- however neither have been examined in a prospective trial.

Endotracheal intubation is common in the care of critically ill patients. Procedural complications including hypoxia and hypotension are frequent in urgent and emergent intubation and associated with an increased risk of death. The use of a written, pre-procedure checklist and positioning the patient with the head of the bed elevated have been proposed as interventions capable of preventing complications during non-elective intubation and are used intermittently in routine care -- however neither have been examined in a prospective trial. The investigators propose a randomized trial comparing use of a written checklist versus no written checklist and ramped versus sniffing position for endotracheal intubation of critically ill adults.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

260

Conditions

Respiratory Failure

Interventions

Written ChecklistPROCEDURE

Use of a written checklist pre and peri-intubation

Head of Bed UpPROCEDURE

Raising the patient's head of bed to 25 degrees

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Airway management events will be included in which: 1. Patient is admitted to the Medical Intensive Care Unit (MICU) 2. Planned procedure is endotracheal intubation 3. Planned operator is a Pulmonary and Critical Care Medicine (PCCM) fellow 4. Administration of sedation and/or neuromuscular blockade is planned 5. Age ≥ 18 years old Exclusion Criteria: Airway management events will be excluded in which: 1. Operator feels specific patient positioning during intubation is required 2. Urgency of intubation precludes safe performance of study procedures 3. Operator feels an alternative pre-procedure checklist or no checklist is required

Locations (5)

University of Alabama - Birmingham

Birmingham, Alabama, United States

Louisiana State University School of Medicine

New Orleans, Louisiana, United States

Ochsner Medical Center

New Orleans, Louisiana, United States

Vanderbilt University

Nashville, Tennessee, United States

Outcomes

Primary Outcomes

Lowest Arterial Oxygen Saturation (Both positioning and Checklist interventions)

Lowest non-invasively measured arterial oxygen saturation between the time of induction or neuromuscular blockade and two minutes after completion of the airway management procedure