Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning
Yonathan Freund
(1)
,
Damien Viglino
(2)
,
Marine Cachanado
(3)
,
Clémentine Cassard
(4)
,
Emmanuel Montassier
(5, 6, 7)
,
Bénedicte Douay
(8)
,
Jérémy Guenezan
(9, 10)
,
Pierrick Le Borgne
(11)
,
Youri Yordanov
(12)
,
Armelle Severin
,
Mélanie Roussel
,
Matthieu Daniel
(13, 14)
,
Adrien Marteau
(15)
,
Nicolas Peschanski
(16, 17)
,
Dorian Teissandier
(18, 19)
,
Richard Macrez
(20)
,
Julia Morere
(21)
,
Tahar Chouihed
(22, 23, 24, 25, 26)
,
Damien Roux
(27, 28)
,
Frédéric Adnet
(29, 30, 31)
,
Ben Bloom
(32)
,
Anthony Chauvin
(33)
,
Tabassome Simon
(34)
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 = Nantes University Hospital
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 UFR Santé [Poitiers] - Université de Poitiers – UFR Santé [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 [Pontchaillou]
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
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 = Nantes University Hospital
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 UFR Santé [Poitiers] - Université de Poitiers – UFR Santé [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 [Pontchaillou]
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
Emmanuel Montassier
- Fonction : Auteur
Armelle Severin
- Fonction : Auteur
Mélanie Roussel
- Fonction : Auteur
Matthieu Daniel
- Fonction : Auteur
- PersonId : 1356887
- ORCID : 0000-0002-5605-3131
- IdRef : 254238149
Dorian Teissandier
- Fonction : Auteur
- PersonId : 1269807
- IdHAL : dorianteissandier
Tahar Chouihed
- 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