JAMA
November 29, 2023
Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning
Mazen Kherallah
Summarized by:
In comatose patients with suspected acute poisoning and a Glasgow Coma Scale score less than 9, does a conservative airway management strategy involving the withholding of intubation lead to better clinical outcomes compared to the routine practice of tracheal intubation, in terms of in-hospital mortality, length of ICU stay, and length of hospital stay?
Population:
Comatose patients with suspected acute poisoning.
Glasgow Coma Scale score < 9.
Study conducted in France, including participants from 20 emergency departments and 1 ICU.
225 patients (mean age 33 years; 38% female).
Intervention:
Conservative airway management strategy involving withholding of intubation.
Comparison:
Routine practice of tracheal intubation.
Outcome:
No in-hospital deaths in either group.
Clinical benefit in the intervention group (win ratio 1.85; 95% CI, 1.33 to 2.58).
Lower proportion of adverse events in the intervention group (6% vs 14.7%; absolute risk difference, 8.6%).
Pneumonia occurrence: 6.9% in the intervention group and 14.7% in the control group (absolute risk difference, −7.8%).