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General Critical Care

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Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning


Would you intubate a 37 years old who presented with acute alcohol intoxication and GCS of 7 but adequate oxygenation and ventilation?

  • 0%Yes

  • 0%No


Research Question:

What is the effect of withholding intubation compared to routine practice on clinical outcomes in comatose patients with acute poisoning and a Glasgow Coma Scale score of less than 9?


https://jamanetwork.com/journals/jama/fullarticle/2812429


Population: The study involved 225 comatose patients with suspected acute poisoning, having a Glasgow Coma Scale score less than 9, treated in 20 emergency departments and 1 ICU in France.


Intervention: Patients were randomized to undergo a conservative airway strategy where intubation was withheld.


Comparison: This group was compared with another group following routine tracheal intubation practices.


Outcome:

- Primary Outcome Results: There was a significant clinical benefit in the intervention group, indicated by a win ratio of 1.85. The primary endpoint included measures of in-hospital death, length of ICU stay, and length of hospital stay.

- Secondary Outcome Results: The intervention group had a lower incidence of adverse events (6% vs 14.7% in the control group) and pneumonia (6.9% vs 14.7% in the control group).



Conclusion:

In this study, withholding intubation in comatose patients with acute poisoning was associated with improved outcomes compared to routine intubation. This included a significant reduction in ICU and hospital stay lengths, alongside lower incidences of adverse events and pneumonia.


Ibrahim Ameen
Ahmed Argawi
Noor Shah
A S
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