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Checklists and Upright Positioning in Endotracheal Intubation of Critically Ill Patients (Check-UP) Trial (Check-UP)

16 september 2016 uppdaterad av: Todd Rice, Vanderbilt University
The use of a written, pre-procedure checklist and positioning the patient with the head of the bed elevated have been proposed as interventions capable of preventing complications during non-elective intubation and are used intermittently in routine care -- however neither have been examined in a prospective trial.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Endotracheal intubation is common in the care of critically ill patients. Procedural complications including hypoxia and hypotension are frequent in urgent and emergent intubation and associated with an increased risk of death. The use of a written, pre-procedure checklist and positioning the patient with the head of the bed elevated have been proposed as interventions capable of preventing complications during non-elective intubation and are used intermittently in routine care -- however neither have been examined in a prospective trial. The investigators propose a randomized trial comparing use of a written checklist versus no written checklist and ramped versus sniffing position for endotracheal intubation of critically ill adults.

Studietyp

Interventionell

Inskrivning (Faktisk)

260

Fas

  • Fas 4

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Förenta staterna
    • Alabama
      • Birmingham, Alabama, Förenta staterna, 35294
        • University of Alabama - Birmingham
    • Louisiana
      • New Orleans, Louisiana, Förenta staterna, 70115
        • Ochsner Medical Center
      • New Orleans, Louisiana, Förenta staterna, 70112
        • Louisiana State University School of Medicine
    • Tennessee
      • Nashville, Tennessee, Förenta staterna, 37232
        • Vanderbilt University
    • Washington
      • Seattle, Washington, Förenta staterna, 98104
        • University of Washington

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

Airway management events will be included in which:

  1. Patient is admitted to the Medical Intensive Care Unit (MICU)
  2. Planned procedure is endotracheal intubation
  3. Planned operator is a Pulmonary and Critical Care Medicine (PCCM) fellow
  4. Administration of sedation and/or neuromuscular blockade is planned
  5. Age ≥ 18 years old

Exclusion Criteria:

Airway management events will be excluded in which:

  1. Operator feels specific patient positioning during intubation is required
  2. Urgency of intubation precludes safe performance of study procedures
  3. Operator feels an alternative pre-procedure checklist or no checklist is required

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Förebyggande
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Inget ingripande: Sniffing Position, No Checklist
Patient in the sniffing position without the use of a written checklist
Aktiv komparator: Sniffing Position, Checklist
Patient in the sniffing position with the use of a written checklist
Procedur: Written Checklist
Use of a written checklist pre and peri-intubation
Andra namn:
  • Checklista
Aktiv komparator: Head of Bed Up, No Checklist
Patient with the head of bed up and without the use of a checklist
Procedur: Head of Bed Up
Raising the patient's head of bed to 25 degrees
Andra namn:
  • Patient Positioning
  • Sniff Position
Aktiv komparator: Head of Bed Up, Checklist
Patient with the head of bed up and with the use of a checklist
Procedur: Written Checklist
Use of a written checklist pre and peri-intubation
Andra namn:
  • Checklista
Procedur: Head of Bed Up
Raising the patient's head of bed to 25 degrees
Andra namn:
  • Patient Positioning
  • Sniff Position

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Lowest Arterial Oxygen Saturation (Both positioning and Checklist interventions)
Tidsram: Time of Induction through 2 minutes after successful intubation
Lowest non-invasively measured arterial oxygen saturation between the time of induction or neuromuscular blockade and two minutes after completion of the airway management procedure
Time of Induction through 2 minutes after successful intubation
Lowest Systolic Blood Pressure (Checklist intervention only)
Tidsram: Time of Induction through 2 minutes after successful intubation
Lowest non-invasively or invasively measured systolic blood pressure between medication administration and 2 minutes following successful placement of an endotracheal tube (in checklist comparison only)
Time of Induction through 2 minutes after successful intubation

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Incidence of Desaturation
Tidsram: Time of Induction through 2 minutes after successful intubation
Decrease in oxygen saturation of greater than 3% from induction to lowest oxygen saturation
Time of Induction through 2 minutes after successful intubation
Incidence of Hypoxemia
Tidsram: Time of Induction through 2 minutes after successful intubation
Defined by lowest oxygen saturation less than 90% and severe hypoxemia as defined by lowest oxygen saturation less than 80%
Time of Induction through 2 minutes after successful intubation
Change in Saturation
Tidsram: Time of Induction through 2 minutes after successful intubation
Change in oxygen saturation from baseline to lowest oxygen saturation
Time of Induction through 2 minutes after successful intubation
Grade of First Glottic View
Tidsram: Time of Induction through 2 minutes after successful intubation
Cormack-Lehane grade of view on first intubation attempt
Time of Induction through 2 minutes after successful intubation
First Pass Success
Tidsram: Time of Induction through 2 minutes after successful intubation
Placement of an endotracheal tube in the trachea after the first insertion of the laryngoscope into the oral cavity without the use of any other devices
Time of Induction through 2 minutes after successful intubation
Number of Intubation Attempts
Tidsram: Time of Induction through 2 minutes after successful intubation
Number of attempts required for successful tube placement
Time of Induction through 2 minutes after successful intubation
Time to Intubation
Tidsram: Time of Induction through 2 minutes after successful intubation
Time (in minutes) from pushing of induction meds to successful placement of endotracheal tube
Time of Induction through 2 minutes after successful intubation
Need for Assistance
Tidsram: Time of Induction through 2 minutes after successful intubation
Incidence of need for additional intubating equipment, second operator
Time of Induction through 2 minutes after successful intubation
Non-hypoxic complications
Tidsram: Time of Induction through 2 minutes after successful intubation
Incidence of non-oxygenation complications - composite of all other recorded complications
Time of Induction through 2 minutes after successful intubation
Malposition of Endotracheal Tube
Tidsram: Time of Induction through 2 minutes after successful intubation
Incidence of post-intubation tube malposition on Chest X-Ray (CXR)
Time of Induction through 2 minutes after successful intubation
Repositioning Patient
Tidsram: Time of Induction through 2 minutes after successful intubation
Incidence of repositioning patient after procedure initiation
Time of Induction through 2 minutes after successful intubation
In-Hospital Mortality
Tidsram: From enrollment through the earlier of hospital discharge or 365 days
Death before hospital discharge
From enrollment through the earlier of hospital discharge or 365 days
Ventilator-free Days
Tidsram: From enrollment through study day 28
Days alive and free from mechanical ventilation
From enrollment through study day 28
ICU-Free Days
Tidsram: From enrollment through study day 28
Days alive and out of the ICU
From enrollment through study day 28

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Vanderbilt University

Utredare

  • Studierektor: Todd W Rice, MD, MSc, Vanderbilt University Medical Center

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 juli 2015

Primärt slutförande (Faktisk)

1 september 2016

Avslutad studie (Faktisk)

1 september 2016

Studieregistreringsdatum

Först inskickad

6 juli 2015

Först inskickad som uppfyllde QC-kriterierna

10 juli 2015

Första postat (Uppskatta)

14 juli 2015

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

19 september 2016

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

16 september 2016

Senast verifierad

1 september 2016

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • 150897

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .

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