Apneic Oxygenation Including Precipitous Intubations During RSI in the ED
| Status: | Recruiting |
|---|---|
| Conditions: | Pulmonary |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/31/2019 |
| Start Date: | March 1, 2019 |
| End Date: | February 1, 2020 |
| Contact: | Ilya Ostrovsky, MD |
| Email: | ostrovil@njms.rutgers.edu |
| Phone: | 9739721428 |
Randomized Controlled Trial of Apneic Oxygenation Including Precipitous Intubations During RSI in the Emergency Department
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.
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.
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:
- Exclusion criteria include patients who are in cardiac arrest, or if the patient
received any positive pressure ventilation (i.e, BPAP, CPAP, BVM) in the emergency
department before RSI.
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