Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Facilitating EndotracheaL Intubation by Laryngoscopy Technique and Apneic Oxygenation Within the Intensive Care Unit
Brief Summary: 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.


Options:
A: Arm Label: Nasal high-flow oxygen therapy; Type: EXPERIMENTAL; Interventions: Device: Optiflow (Fisher & Paykel Healthcare) | Arm Label: Venturi mask oxygen therapy; Type: ACTIVE_COMPARATOR; Interventions: Device: Venturi mask | Intervention Type: DEVICE; Name: Optiflow (Fisher & Paykel Healthcare); Assigned to Arm(s): Nasal high-flow oxygen therapy | Intervention Type: DEVICE; Name: Venturi mask; Assigned to Arm(s): Venturi mask oxygen therapy
B: Arm Label: NIV; Type: EXPERIMENTAL; Interventions: Procedure: Noninvasive ventilation | Arm Label: HFNC; Type: ACTIVE_COMPARATOR; Interventions: Procedure: High Flow nasal canula oxygen therapy | Intervention Type: PROCEDURE; Name: High Flow nasal canula oxygen therapy; Assigned to Arm(s): HFNC | Intervention Type: PROCEDURE; Name: Noninvasive ventilation; Assigned to Arm(s): NIV
C: Arm Label: PREOXYFLOW; Type: EXPERIMENTAL; Interventions: Device: PREOXYFLOW | Arm Label: STANDARD FACE MASK; Type: ACTIVE_COMPARATOR; Interventions: Procedure: STANDARD FACE MASK | Intervention Type: DEVICE; Name: PREOXYFLOW; Assigned to Arm(s): PREOXYFLOW | Intervention Type: PROCEDURE; Name: STANDARD FACE MASK; Assigned to Arm(s): STANDARD FACE MASK
D: Arm Label: VL and AO; Type: ACTIVE_COMPARATOR; Interventions: Device: Apneic Oxygenation, Device: No Apneic Oxygenation | Arm Label: DL and AO; Type: ACTIVE_COMPARATOR; Interventions: Device: Apneic Oxygenation, Device: No Apneic Oxygenation | Arm Label: VL and no AO; Type: ACTIVE_COMPARATOR; Interventions: Device: Video Laryngoscopy, Device: Direct Laryngoscopy | Arm Label: DL and no AO; Type: ACTIVE_COMPARATOR; Interventions: Device: Video Laryngoscopy, Device: Direct Laryngoscopy | Intervention Type: DEVICE; Name: Video Laryngoscopy; Assigned to Arm(s): DL and no AO, VL and no AO | Intervention Type: DEVICE; Name: Apneic Oxygenation; Assigned to Arm(s): DL and AO, VL and AO | Intervention Type: DEVICE; Name: Direct Laryngoscopy; Assigned to Arm(s): DL and no AO, VL and no AO | Intervention Type: DEVICE; Name: No Apneic Oxygenation; Assigned to Arm(s): DL and AO, VL and AO

Answer: D