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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
10
Providing oxygenation through nasal cannula during the apneic phase of endotracheal intubation.
University Hospital
Newark, New Jersey, United States
Lowest oxygen saturation overall
Lowest oxygen saturation between overall control and intervention groups
Time frame: Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation
Lowest oxygen saturation precipitous intubations
Lowest oxygen saturation between control and intervention groups that did not receive adequate pre-oxygenation only
Time frame: Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation
Lowest oxygen saturation pre-oxygenation
Lowest oxygen saturation between control and intervention groups that did receive
Time frame: Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation
Difference in baseline and final oxygen saturation
Time frame: Decision to intubate through 2 minutes after completion of endotracheal intubation
Difference in oxygen saturation before and after apneic period
Time frame: Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation
Desaturation
The proportion of patients who desaturate below 90%
Time frame: Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation
number of attempts
number of times laryngoscope is placed into the mouth in an attempt to pass an endotracheal tube
Time frame: From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes.
Need for second operator
A second physician had to attempt intubation
Time frame: From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes.
Need for additional intubating equipment
The operator needed to change or add equipment to facilitate intubation
Time frame: From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes.
Esophageal intubations
The proportion of intubations that resulted in the endotracheal tube being placed in the esophagus
Time frame: From first attempt at intubation through entire ED stay, approximately 6 hours.
Procedural hypotension
Proportion of became hypotensive at any point during the intubation procedure
Time frame: Initiation of neuromuscular blockade to 2 minutes after completion of endotracheal intubation
Aspiration
Proportion of patients that had evidence of aspiration
Time frame: Within 24 hours after intubation procedure was complete
Hospital length of stay
Number of days patient is hospitalized
Time frame: Up to 28 days after intubation
Number of days intubated
Time frame: Up to 28 days after intubation
In-hospital mortality
Time frame: Up to 28 days after intubation
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