Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning-Reference-Cited by-同舟云学术

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning

Published:2023-12-19 Issue:23 Volume:330 Page:2267
ISSN:0098-7484
Container-title:JAMA
language:en
Short-container-title:JAMA

Author:

Freund Yonathan¹²,Viglino Damien³,Cachanado Marine⁴,Cassard Clémentine²,Montassier Emmanuel⁵,Douay Bénedicte⁶,Guenezan Jérémy⁷,Le Borgne Pierrick⁸,Yordanov Youri¹⁹,Severin Armelle¹⁰,Roussel Mélanie¹¹,Daniel Matthieu¹²,Marteau Adrien¹³,Peschanski Nicolas¹⁴¹⁵,Teissandier Dorian¹⁶¹⁷,Macrez Richard¹⁸,Morere Julia¹⁹,Chouihed Tahar²⁰,Roux Damien²¹,Adnet Frédéric²²,Bloom Ben²³,Chauvin Anthony²⁴,Simon Tabassome¹⁴

Affiliation:

1. Sorbonne Université, IMProving Emergency Care FHU, Paris, France

2. Emergency Department and Service Mobile d’Urgence et de Réanimation (SMUR), Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France

3. Emergency Department, Grenoble-Alpes University Hospital, and University Grenoble-Alpes, HP2 Laboratory INSERM U 1300, Grenoble, France

4. Department of Clinical Pharmacology and Clinical Research Platform Paris-East, AP-HP, Sorbonne University, St Antoine Hospital, Paris, France

5. Emergency Department and SMUR, Nantes Université, CHU Nantes, INSERM UMR 1064, Nantes, France

6. Emergency Department and SMUR, Hôpital Beaujon AP-HP, Clichy, France

7. Emergency Department, University Hospital of Poitiers, Poitiers, France

8. Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France and INSERM UMR 1260, Regenerative NanoMedicine, Fédération de Médecine Translationnelle, University of Strasbourg, Strasbourg, France

9. Emergency Department, Hôpital Saint Antoine AP-HP, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France

10. SAMU 92–SMUR Raymond Poincaré, Raymond Poincaré Hospital, AP-HP, Paris, France

11. Emergency Department, Univ Rouen Normandie, CHU Rouen, Rouen, France

12. Emergency Department, SAMU-SMUR et Secours en Milieu Périlleux, CHU de La Réunion Site Nord Félix Guyon, La Réunion, France

13. Emergency Department, Centre Hospitalier Universitaire Sud Réunion, Saint Pierre, La Réunion, France

14. Emergency Department and SAMU35-SMUR, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France

15. Faculté de Médecine, Université de Rennes, Rennes, France

16. Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France

17. Université Clermont Auvergne, INRAE, UNH, Clermont-Ferrand, France

18. Emergency Department, University hospital of Caen, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Institut Blood and Brain Normandie University, Caen, France

19. Emergency Department and SMUR, Hôpital Edouard Herriot, Lyon, France

20. Emergency Department, University Hospital of Nancy, INSERM, UMR_S 1116, University Hospital of Nancy, Nancy, France

21. Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France

22. Emergency Department and Service Mobile d’Urgence et de Réanimation SMUR, Hôpital Avicenne, AP-HP, Bobigny, France

23. Emergency Department, Royal London Hospital, London, United Kingdom

24. Emergency Department, Hôpital Lariboisiere AP-HP, Paris, France and INSERM U942 MASCOT, University of Paris, Paris, France

Abstract

ImportanceTracheal intubation is recommended for coma patients and those with severe brain injury, but its use in patients with decreased levels of consciousness from acute poisoning is uncertain.ObjectiveTo determine the effect of intubation withholding vs routine practice on clinical outcomes of comatose patients with acute poisoning and a Glasgow Coma Scale score less than 9.Design, Setting, and ParticipantsThis was a multicenter, randomized trial conducted in 20 emergency departments and 1 intensive care unit (ICU) that included comatose patients with suspected acute poisoning and a Glasgow Coma Scale score less than 9 in France between May 16, 2021, and April 12, 2023, and followed up until May 12, 2023.InterventionPatients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice.Main Outcomes and MeasuresThe primary outcome was a hierarchical composite end point of in-hospital death, length of ICU stay, and length of hospital stay. Key secondary outcomes included adverse events resulting from intubation as well as pneumonia within 48 hours.ResultsAmong the 225 included patients (mean age, 33 years; 38% female), 116 were in the intervention group and 109 in the control group, with respective proportions of intubations of 16% and 58%. No patients died during the in-hospital stay. There was a significant clinical benefit for the primary end point in the intervention group, with a win ratio of 1.85 (95% CI, 1.33 to 2.58). In the intervention group, there was a lower proportion with any adverse event (6% vs 14.7%; absolute risk difference, 8.6% [95% CI, −16.6% to −0.7%]) compared with the control group, and pneumonia occurred in 8 (6.9%) and 16 (14.7%) patients, respectively (absolute risk difference, −7.8% [95% CI, −15.9% to 0.3%]).Conclusions and RelevanceAmong comatose patients with suspected acute poisoning, a conservative strategy of withholding intubation was associated with a greater clinical benefit for the composite end point of in-hospital death, length of ICU stay, and length of hospital stay.Trial RegistrationClinicalTrials.gov Identifier: NCT04653597

Publisher

American Medical Association (AMA)

Subject

General Medicine

Link

https://jamanetwork.com/journals/jama/articlepdf/2812429/jama_freund_2023_oi_230143_1702929659.75338.pdf

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