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Article Dans Une Revue JAMA Cardiology Année : 2023

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning

1 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
2 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
3 CHU Saint-Antoine [AP-HP]
4 CHU Pitié-Salpêtrière [AP-HP]
5 CHU Nantes - Centre Hospitalier Universitaire de Nantes
6 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
7 Team 6 - U1064 Inserm - CR2TI - Team 6 : Impact of acute inflammation on host pathogen interactions and lung homeostasis
8 Hôpital Beaujon [AP-HP]
9 Université de Poitiers - Faculté de Médecine et de Pharmacie
10 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
11 I2BC - Institut de Biologie Intégrative de la Cellule
12 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
13 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
14 EPI - Études Pharmaco-Immunologie
15 UHP - Université Henri Poincaré - Nancy 1
16 UR Médecine - Université de Rennes - Faculté de Médecine
17 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
18 Pôle Urgences [CHU Clermont-Ferrand]
19 UNH - Unité de Nutrition Humaine
20 PhIND - Physiopathologie et imagerie des troubles neurologiques
21 MMG - Marseille medical genetics - Centre de génétique médicale de Marseille
22 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
23 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
24 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
25 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
26 Service d’Accueil des urgences [CHRU Nancy]
27 Hôpital Louis Mourier - AP-HP [Colombes]
28 INEM - UM 111 (UMR 8253 / U1151) - Institut Necker Enfants-Malades
29 Hôpital Avicenne [AP-HP]
30 SAMU 93 [Bobigny]
31 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
32 Royal London Hospital
33 Hôpital Lariboisière-Fernand-Widal [APHP]
34 SU - Sorbonne Université
Armelle Severin
  • Fonction : Auteur
Mélanie Roussel
  • Fonction : Auteur
Ben Bloom
  • Fonction : Auteur

Résumé

Importance : 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. Objective : 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. Design, Setting, and Participants : 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. Intervention : Patients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice. Main Outcomes and Measures : 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. Results : 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%]). Conclusions and Relevance : 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. Trial Registration : ClinicalTrials.gov Identifier: NCT04653597

Dates et versions

inserm-04391165 , version 1 (12-01-2024)

Identifiants

Citer

Yonathan Freund, Damien Viglino, Marine Cachanado, Clémentine Cassard, Emmanuel Montassier, et al.. Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning. JAMA Cardiology, 2023, 330 (23), pp.2267-2274. ⟨10.1001/jama.2023.24391⟩. ⟨inserm-04391165⟩
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