Withholding Intubation Benefits Comatose Poisoning Patients

TOPLINE:

In comatose patients with a suspicion of acute poisoning, opting for a conservative approach by refraining from intubation has a significant clinical advantage concerning the combined outcomes of in-hospital mortality, duration of intensive care unit (ICU) stay, and length of hospital stay.

METHODOLOGY:

• This multicenter randomized trial conducted in 20 emergency departments (EDs) and 1 ICU in France included comatose patients with suspected acute poisoning.

• 225 patients were randomly assigned to either a conservative strategy of withholding intubation or a routine practice where the decision for intubation is at the physician’s discretion.

• Each patient comparison resulted in a hierarchical definition of win, loss, or tie based on their respective outcomes.

• The primary outcome was a hierarchical composite end point of in-hospital death, duration of ICU stay, and length of hospital stay.

TAKEAWAY:

• No deaths were reported in either group.

• The conservative strategy of withholding intubation significantly improved the composite primary end point, with a win ratio of 1.85 (P < .001).

• The conservative approach also led to a lower rate of ICU admissions (absolute risk difference, −29.2 percentage points).

• Patients in the conservative strategy group experienced:

  • Fewer adverse events from intubation (absolute risk difference, −8.6 percentage points).

  • Lower rates of pneumonia after intubation (absolute risk difference, −7.8 percentage points).

  IN PRACTICE:

  The authors wrote that these findings may fill a gap in the existing literature which suggested that intubating patients for airway protection to limit the risk of aspiration pneumonia may in fact increase the risk of pneumonia.

  SOURCE:

  The study, with first author Yonathan Freund, was published online on November 29 in the JAMA .

  LIMITATIONS:

  Lack of blinding was a limitation of this trial. Also, some patients were intubated in the ED or the ICU and not the prehospital setting.

  DISCLOSURES:

  The study was funded by a grant from the French Ministry of Health. One author declared receiving personal fees from Ablative Solutions, Air Liquide, AstraZeneca, Sanofi, Servier, Novartis, and 4Living Biotech.

  Source: Read Full Article

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