Neurologic Function Post Intubation

Study Overview
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Brief Summary
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The frequency of oxygen desaturation during emergency intubation is not uncommon. However, the significance and clinical sequalae of hypoxia during emergency intubation in critically ill, non-trauma patients is not known. Therefore, the aim of this study is to evaluate neurologic function post-intubation of critically ill, non-trauma patients. Providing knowledge on whether the degree of hypoxia during emergency intubation is associated with worse neurologic outcomes, will guide clinical practice to ameliorate that level of hypoxia

Detailed Description
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Critically ill patients undergoing emergent endotracheal intubation are at risk for oxygen desaturation in a variety of acute care settings. Such complication could arise from patient, operator, or procedure related factors. Evidence suggests that rapid sequence intubation (RSI) improves first-pass success and reduces complications in the critically ill. Nonetheless, the procedure is not without risks. In fact, emergency intubation is associated a reported oxygen desaturation rate of 10.9% - 33.5%. High quality pre-oxygenation has been shown to prolong time to desaturation during emergency airway management. Despite advances preoxygenation techniques, a significant number of patients undergoing emergency intubation still experience desaturation. Most of the time this is transient and easily reversible. Occasionally however, desaturation becomes critical and may result in devastating complications such as dysrhythmias or cardiopulmonary arrest. The brain consumes a significant amount of energy and is exquisitely sensitive to hypoxia and hypoperfusion. Hypoxic brain injury occurs whenever oxygen delivery to the brain is compromised. The role of secondary brain insults including hypoxia and hypotension, in traumatic brain injury (TBI) is well established. Previous literature has demonstrated that a single event of hypoxemia in a head-injured patient substantially increases morbidity and mortality. This has resulted in airway management being a cornerstone in the care of unconscious TBI patients, to ensure adequate oxygen delivery to the injured brain. However, the significance and clinical sequalae of hypoxia during emergency intubation in critically ill, non-trauma patients is not known. Therefore, the aim of this study is to evaluate neurologic function post-intubation of critically ill, non-trauma patients.

Official Title
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Post Intubation Neurologic Outcomes in Critically Ill Adults

Conditions
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Intubation Complication

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Good baseline neurologic function (Modified Rankin Scale: 1-3) Emergency departments Critical care units In-patient floors Patients undergoing emergent intubations as determined by the treating physician Age> 17 years old Good baseline modified rankin scale (mRs 1-3) Exclusion Criteria: Pediatric patients (17 years of age of less) Pregnant patients Intubations occurring in the operating room Prisoners Trauma Status epilepticus Primary intracranial pathology Cardiopulmonary arrest Poor baseline neurologic function (Modified Rankin Scale: 4-5) Pre-Hospital Intubation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hypoxic group<br>Participants with hypoxia during intubation (after induction and before endotracheal tube placement) | |
| Non-hypoxic group<br>Participants without hypoxia during intubation (after induction and before endotracheal tube placement) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Rankin Scale (mRs) | A validated 6-point scale for measuring the degree of disability in the daily activities of people suffering neurological impairment. The scale runs from 0-6, in which 0 indicates perfect health without disability and 6 indicates the worst outcome which is death. | Up to 30-days of intubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In-hospital Mortality | Death during hospital stay | Up to 30-days of intubation | 
| ICU Length of Stay | Duration of stay in intensive care unit | Up to 30-days from intubation | 
| Hospital Length of Stay | Duration of stay in hospital | Up to 30-days of intubation | 
| Incidence of Aspiration | Pulmonary aspiration confirmed by chest X-ray or chest CT | Up to 14-days of intubation | 
| Post-Intubation Complications | Complications arising during the early post-intubation phase | Within 24-hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency Intubation, Hypoxia, Neurologic Function