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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Apneic Oxygenation | Experimental | Participants receiving apneic oxygenation |
|
| No Apneic Oxygenation | No Intervention | Participants not receiving apneic oxygenation |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Apneic oxygenation during endotracheal intubation | Other | Providing oxygenation through nasal cannula during the apneic phase of endotracheal intubation. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Lowest oxygen saturation overall | Lowest oxygen saturation between overall control and intervention groups | Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation |
| Measure | Description | Time Frame |
|---|---|---|
| Lowest oxygen saturation precipitous intubations | Lowest oxygen saturation between control and intervention groups that did not receive adequate pre-oxygenation only | Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation |
| Lowest oxygen saturation pre-oxygenation |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ilya Ostrovsky, MD | Rutgers, The State University of New Jersey | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital | Newark | New Jersey | 07103 | United States |
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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Lowest oxygen saturation between control and intervention groups that did receive |
| Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation |
| Difference in baseline and final oxygen saturation | Decision to intubate through 2 minutes after completion of endotracheal intubation |
| Difference in oxygen saturation before and after apneic period | Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation |
| Desaturation | The proportion of patients who desaturate below 90% | 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 | 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 | 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 | 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 | 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 | Initiation of neuromuscular blockade to 2 minutes after completion of endotracheal intubation |
| Aspiration | Proportion of patients that had evidence of aspiration | Within 24 hours after intubation procedure was complete |
| Hospital length of stay | Number of days patient is hospitalized | Up to 28 days after intubation |
| Number of days intubated | Up to 28 days after intubation |
| In-hospital mortality | Up to 28 days after intubation |