医学
格拉斯哥昏迷指数
彗差(光学)
插管
重症监护室
随机对照试验
临床终点
肺炎
不利影响
急诊医学
麻醉
重症监护医学
外科
内科学
光学
物理
作者
Yonathan Freund,Damien Viglino,Marine Cachanado,Clémentine Cassard,Emmanuel Montassier,Bénedicte Douay,Jérémy Guenezan,Pierrick Le Borgne,Youri Yordanov,Armelle Séverin,Mélanie Roussel,Matthieu Daniel,Adrien Marteau,Nicolas Peschanski,Dorian Teissandier,Richard Macrez,Jean‐François Morère,Tahar Chouihed,Damien Roux,Frédéric Adnet,Ben Bloom,Anthony Chauvin,Tabassome Simon
出处
期刊:JAMA
[American Medical Association]
日期:2023-12-19
卷期号:330 (23): 2267-2267
被引量:13
标识
DOI:10.1001/jama.2023.24391
摘要
Tracheal 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.To 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.This 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.Patients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice.The 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.Among 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%]).Among 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.ClinicalTrials.gov Identifier: NCT04653597.