Facilitating EndotracheaL Intubation by Laryngoscopy Technique and Apneic Oxygenation Within the Intensive Care Unit: The FELLOW Study (FELLOW)
2017年4月19日 更新者:David Janz、Vanderbilt University
Facilitating EndotracheaL Intubation by Laryngoscopy Technique and Apneic Oxygenation Within the Intensive Care Unit
Respiratory failure requiring endotracheal intubation occurs in as many as 40% of critically ill patients.
Procedural complications including failed attempts at intubation, esophageal intubation, arterial oxygen desaturation, aspiration, hypotension, cardiac arrest, and death are common in this setting.
While there are many important components of successful airway management in critical illness, the maintenance of adequate arterial hemoglobin saturation from procedure initiation until endotracheal tube placement is paramount as desaturation is the most common factor associated with peri-intubation cardiac arrest and death.
Interventions that either shorten the duration of time required for tube placement or prolong the period before desaturation may be effective in improving outcome.
The high rate of complications and the lack of existing evidence regarding the efficacy of current airway management techniques in shortening the time to airway establishment or prolonging the time to desaturation mandates further investigation.
The primary hypothesis is that video laryngoscopy will be superior to direct laryngoscopy in successful first attempt at endotracheal intubation (defined by confirmed placement of an endotracheal tube in the trachea during first laryngoscopy attempt) of medical ICU patients by Pulmonary/Critical Care Medicine fellows after controlling for the operator's past number of procedures with the equipment used.
Also, the investigators hypothesize that the provision of apneic oxygenation during the endotracheal intubation procedure (defined as a nasal cannula with 15 liters per minute of oxygen flow placed prior to sedation or neuromuscular blockade and maintained until after completion of the procedure) will result in a higher arterial oxygen saturation nadir (defined as lowest noninvasive oxygenation saturation value observed between the administration of sedation and/or neuromuscular blockade and 2 minutes after successfully secured airway or death) compared to no apneic oxygenation.
研究概览
研究类型
介入性
注册 (实际的)
150
阶段
- 不适用
联系人和位置
本节提供了进行研究的人员的详细联系信息,以及有关进行该研究的地点的信息。
学习地点
-
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Tennessee
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Nashville、Tennessee、美国、37232
- Vanderbilt University Medical Center
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-
参与标准
研究人员寻找符合特定描述的人,称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
Inclusion Criteria:
- Adults
- Medical ICU Patients
- Require endotracheal intubation
- Endotracheal intubation to be performed by Pulmonary/Critical Care Medicine Fellow
- Sedation and/or neuromuscular blockade is planned for the procedure
Exclusion Criteria:
- Operators other than Pulmonary/Critical Care Medicine Fellows
- The operator predetermines that the patient requires specific intubating equipment or oxygenation technique will be required for the safe performance of the procedure
学习计划
本节提供研究计划的详细信息,包括研究的设计方式和研究的衡量标准。
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:阶乘赋值
- 屏蔽:四人间
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
有源比较器:VL and AO
Video laryngoscopy and apneic oxygenation
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有源比较器:DL and AO
Direct Laryngoscopy and apneic oxygenation
|
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有源比较器:VL and no AO
Video Laryngoscopy and no apneic oxygenation
|
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有源比较器:DL and no AO
Direct Laryngoscopy and no apneic oxygenation
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Successful First Attempt at Endotracheal Intubation (Defined by Confirmed Placement of an Endotracheal Tube in the Trachea During First Laryngoscopy Attempt) After Controlling for the Operator's Past Number of Procedures With the Equipment Used.
大体时间:1 hour
|
The primary outcome for the video laryngoscopy compared with direct laryngoscopy arm of the study will be the successful first attempt at endotracheal intubation (defined by confirmed placement of an endotracheal tube in the trachea during first laryngoscopy attempt) after controlling for the operator's past number of procedures with the equipment used.
|
1 hour
|
Arterial Oxygen Saturation Nadir (Defined as Lowest Noninvasive Oxygenation Saturation Value Observed Between the Administration of Sedation and/or Neuromuscular Blockade and 2 Minutes After Successfully Secured Airway or Death).
大体时间:1 hour
|
The primary outcome for the apneic oxygenation arm of the study is arterial oxygen saturation nadir (defined as lowest noninvasive oxygenation saturation value observed between the administration of sedation and/or neuromuscular blockade and 2 minutes after successfully secured airway or death).
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1 hour
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Procedure-related Mortality
大体时间:1 hour
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Death within 1 hour of beginning the procedure
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1 hour
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ICU-mortality
大体时间:28 days
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Death from any cause in the ICU and at anytime after the procedure
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28 days
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Adjusted Lowest Arterial Oxygen Saturation During Procedure
大体时间:1 hour
|
Arterial oxygen saturation nadir (defined as lowest noninvasive oxygenation saturation value observed between the administration of sedation and/or neuromuscular blockade and 2 minutes after successfully secured airway or death) adjusted for arterial oxygen saturation at the time of administering intubation drugs.
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1 hour
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Ventilator-free Days
大体时间:28 days
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Number of days alive and free of mechanical ventilation after endotracheal intubation
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28 days
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Number of Esophageal Intubations Per Group
大体时间:1 hour
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Number of esophageal intubations Per Study Group
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1 hour
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Grade View of the Glottis
大体时间:1 hour
|
Best Cormack-Lehane grade view of the glottis (grade 1-4) on first laryngoscopy attempt.
Higher grades on the 1-4 scale indicate worse glottic views.
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1 hour
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 首席研究员:Matthew W Semler, MD、Vanderbilt University
- 学习椅:Todd W Rice, MD, MSc、Vanderbilt University
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查,以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始
2014年2月1日
初级完成 (实际的)
2015年2月1日
研究完成 (实际的)
2015年2月1日
研究注册日期
首次提交
2014年1月27日
首先提交符合 QC 标准的
2014年1月30日
首次发布 (估计)
2014年1月31日
研究记录更新
最后更新发布 (实际的)
2017年5月24日
上次提交的符合 QC 标准的更新
2017年4月19日
最后验证
2017年4月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.
直接喉镜检查的临床试验
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Institute of Cancer Research, United KingdomCancer Research UK; University of Manchester; University of Sussex完全的
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Stanford UniversitySanta Clara Valley Medical Center撤销
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Novartis Pharmaceuticals完全的