The aim of this prospective randomized trail is to compare nasotracheal versus orotracheal intubation in critically ill patients. We aim to study: * required sedation depth * rate of spontaneous breathing * extend and possibility of physiotherapy * vasopressor and sedative drug doses Participants are randomized 1:1 to receive either nasotracheal or orotracheal intubation.
In the intensive care unit endotracheal intubation and consecutive mechanical ventilation are required for different surgical procedures, examinations and interventions in the ICU or due to respiratory insufficiency. Commonly, intubation is performed orotracheally by direct laryngoscopy after preoxygenation and administration of narcotics and a muscle relaxant. When using this technique sedation is often necessary for tolerance of the orotracheal tube. To avoid the adverse side effects of sedation and mechanical ventilation as for example hypotension, barotrauma, ventilator associated pneumonia, etc., intubation via a nasotracheal approach might be favorable. Retrospective data show that nasotracheal intubation is associated with fewer sedatives, vasopressors, and a higher rate of spontaneous breathing. As there is a paucity of data concerning the use of nasotracheal intubation in the intensive care setting the investigators aim to compare the use of orotracheal and nasotracheal tubes in a prospective randomized trial, using sedation depth as primary outcome measure.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
126
patients requiring tracheal intubation receive nasotracheal intubation
patients requiring tracheal intubation receive orotracheal intubation
Universitätsklinikum Hamburg-Eppendorf
Hamburg, Hamburg, Germany
Sedation depth
fraction of time with a Richmond Agitation and Sedation Scale (RASS) of 0 or -1. Range -5 to +4 with 0 as optimum value representing awake and alert patient.
Time frame: intubation to 72 hours
Sedation depth
fraction of time with Richmond Agitation and Sedation Scale (RASS) above and below targeted RASS of 0 or -1. Range -5 to +4 with 0 as optimum value representing awake and alert patient.
Time frame: intubation to day 10
time to extubation
time until airway device can be removed or patient receives tracheostomy
Time frame: intubation to day 30
rate of extubation
rate of successful removal of airway device without tracheostomy
Time frame: intubation to day 30
tracheostomy
rate of tracheostomy
Time frame: intubation to day 30
spontaneous breathing
rate of spontaneous breathing while on airway device
Time frame: intubation to day 10
vasopressor therapy
doses of vasopressor drugs while on airway device
Time frame: intubation to day 10
sedative drugs
doses of sedative drugs therapy while on airway device
Time frame: intubation to day 10
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ventilator associated pneumonia
incidence of ventilator associated pneumonia associated with airway device
Time frame: intubation to day 30
sinusitis
incidence of sinusitis associated with airway device
Time frame: intubation to day 30
physiotherapy
intensive care unit mobility score (ICU-MS), Range 0 to 10 with higher values indicating higher extend of physiotherapy
Time frame: intubation to day 10
length of intensive care stay
length of intensive care stay
Time frame: intubation to day 30
complications
complications associated with intubation (i.e. bleeding, damage to teeth, aspiration)
Time frame: intubation to day 1
mortality
mortality
Time frame: intubation to day 30