Pragmatic Trial Examining Oxygenation Prior to Intubation (PREOXI)
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ClinicalTrials.gov Identifier: NCT05267652 |
Recruitment Status :
Completed
First Posted : March 4, 2022
Last Update Posted : November 15, 2023
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Condition or disease | Intervention/treatment | Phase |
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Acute Respiratory Failure | Other: Preoxygenation with Non-Invasive Positive Pressure Ventilation Other: Facemask Oxygen | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 1301 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Pragmatic Trial Examining Oxygenation Prior to Intubation |
Actual Study Start Date : | March 10, 2022 |
Actual Primary Completion Date : | October 14, 2023 |
Actual Study Completion Date : | November 11, 2023 |
Arm | Intervention/treatment |
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Active Comparator: Preoxygenation with Non-Invasive Positive Pressure Ventilation Group
Patients assigned to preoxygenation with non-invasive positive pressure ventilation will receive non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation.
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Other: Preoxygenation with Non-Invasive Positive Pressure Ventilation
The delivery of oxygen and ventilation by non-invasive mechanical ventilation via a tight-fitting mask from the initiation of preoxygenation until the initiation of laryngoscopy. Trial protocol will not dictate the brand or type of mechanical ventilator that will be used to deliver non-invasive ventilation. |
Active Comparator: Preoxygenation with Facemask Oxygen Group
For patients randomized to preoxygenation with facemask oxygen, supplemental oxygen will be administered via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians.
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Other: Facemask Oxygen
The delivery of supplemental oxygen via a non-rebreather mask or bag-mask device without manual ventilation from the initiation of preoxygenation until induction. Trial protocol will not dictate the brand or type of facemask. The decision between use of a non-rebreather mask and use of a bag-mask device will be made by treating clinicians. The decision of whether to provide manual ventilation with a bag-mask device between induction and laryngoscopy will be made by treating clinicians. |
- Incidence of Hypoxemia [ Time Frame: from induction to 2 minutes following tracheal intubation ]A peripheral oxygen saturation < 85% during the interval between induction and 2 minutes after tracheal intubation
- Lowest oxygen saturation [ Time Frame: from induction to 2 minutes following tracheal intubation ]Lowest oxygen saturation during the interval between induction and 2 minutes after tracheal intubation
- Incidence of operator-reported aspiration [ Time Frame: from induction to 2 minutes following tracheal intubation ]
- Fraction of inspired oxygen at 24 hours after induction [ Time Frame: 24 hours after induction ]
- Oxygen saturation at 24 hours after induction [ Time Frame: 24 hours after induction ]
- Incidence of pneumothorax [ Time Frame: from induction to 24 hours after induction ]Radiology report of new pneumothorax on chest x-ray in the 24 hours after induction
- Incidence of new infiltrate [ Time Frame: from induction to 24 hours after induction ]Radiology report of new infiltrate on chest imaging in the 24 hours after intubation
- Incidence of severe hypoxemia [ Time Frame: from induction to 2 minutes following tracheal intubation ]Lowest oxygen saturation of <80% between induction and two minutes after tracheal intubation
- Incidence of very severe hypoxemia [ Time Frame: from induction to 2 minutes following tracheal intubation ]Lowest oxygen saturation of <70% between induction and two minutes after tracheal intubation
- Oxygen saturation at induction [ Time Frame: from enrollment to induction ]
- Systolic blood pressure at induction [ Time Frame: from enrollment to induction ]
- Duration from induction to successful intubation [ Time Frame: Duration of procedure (minutes) ]
- Cormack-Lehane grade of glottic view on first attempt [ Time Frame: Duration of procedure (minutes) ]Grade 1: Full view of glottis Grade 2: Partial view of glottis Grade 3: Only epiglottis seen (none of glottis) Grade 4: Neither glottis nor epiglottis seen
- Incidence of successful intubation on the first attempt [ Time Frame: Duration of procedure (minutes) ]Placement of an endotracheal tube in the trachea with a single insertion of a laryngoscope blade into the mouth and either a single insertion of an endotracheal tube into the mouth or a single insertion of a bougie into the mouth followed by a single insertion of an endotracheal tube into the mouth
- Number of laryngoscopy attempts [ Time Frame: Duration of procedure (minutes) ]
- Number of attempts at passing a bougie [ Time Frame: Duration of procedure (minutes) ]
- Number of attempts at passing an endotracheal tube [ Time Frame: Duration of procedure (minutes) ]
- Incidence of cardiovascular collapse [ Time Frame: from induction to 2 minutes following tracheal intubation ]
A composite of one or more of the following between induction and 2 minutes after intubation:
- Systolic blood pressure < 65 mmHg
- New or increased vasopressor
- Cardiac arrest not resulting in death within 1 hour of induction
- Cardiac arrest resulting in death within 1 hour of induction
- 28-day in-hospital mortality [ Time Frame: 28 days ]
- Ventilator-free days to 28 days [ Time Frame: 28 days ]
- ICU-free days to 28 days [ Time Frame: 28 days ]
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patient is located in a participating unit
- Planned procedure is tracheal intubation using a laryngoscope and sedation
- Planned operator is a clinician expected to routinely perform tracheal intubation in the participating unit.
Exclusion Criteria:
- Patient is receiving positive pressure ventilation by a mechanical ventilator, bag-mask device, or laryngeal mask airway
- Patient is known to be less than 18 years old
- Patient is known to be pregnant
- Patient is known to be a prisoner
- Immediate need for tracheal intubation precludes safe performance of study procedures
- Patient is apneic, hypopneic, or has another condition requiring positive pressure ventilation between enrollment and induction
- Operator has determined that preoxygenation with non-invasive positive pressure ventilation or preoxygenation with a facemask is required or contraindicated for optimal care of the patient
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05267652
United States, Alabama | |
UAB Hospital | |
Birmingham, Alabama, United States, 35233 | |
United States, Colorado | |
University of Colorado Denver | |
Aurora, Colorado, United States, 80045 | |
United States, Iowa | |
University of Iowa | |
Iowa City, Iowa, United States, 52242 | |
United States, Louisiana | |
Our Lady of the Lake Regional Medical Center | |
Baton Rouge, Louisiana, United States, 70808 | |
Ochsner Medical Center | Ochsner Health System | |
New Orleans, Louisiana, United States, 70112 | |
United States, Massachusetts | |
Beth Israel Deaconess Medical Center | |
Boston, Massachusetts, United States, 02215 | |
The Lahey Hospital & Medical Center | |
Burlington, Massachusetts, United States, 01805 | |
United States, Minnesota | |
Hennepin County Medical Center | |
Minneapolis, Minnesota, United States, 55415 | |
United States, New York | |
Montefiore Medical Center | |
Bronx, New York, United States, 10467 | |
United States, North Carolina | |
Wake Forest Baptist Medical Center | |
Winston-Salem, North Carolina, United States, 27157 | |
United States, Ohio | |
The Ohio State University Wexner Medical Center | |
Columbus, Ohio, United States, 43210 | |
United States, Oregon | |
Oregon Health & Science University | |
Portland, Oregon, United States, 97239 | |
United States, Tennessee | |
Vanderbilt University Medical Center | |
Nashville, Tennessee, United States, 37232 | |
United States, Texas | |
Brooke Army Medical Center | |
Fort Sam Houston, Texas, United States, 78234 | |
Baylor Scott & White Health | |
Temple, Texas, United States, 76508 | |
United States, Wisconsin | |
University of Wisconsin-Madison | |
Madison, Wisconsin, United States, 53705 |
Principal Investigator: | Jonathan D Casey, MD, MSc | Vanderbilt University Medical Center | |
Principal Investigator: | Adit A Ginde, MD, MPH | University of Colorado, Denver | |
Study Director: | Matthew W Semler, MD, MSc | Vanderbilt University Medical Center | |
Study Chair: | Kevin W Gibbs, MD | Wake Forest University Health Sciences |
Responsible Party: | Jonathan Casey, Assistant Professor, Vanderbilt University Medical Center |
ClinicalTrials.gov Identifier: | NCT05267652 |
Other Study ID Numbers: |
211271 |
First Posted: | March 4, 2022 Key Record Dates |
Last Update Posted: | November 15, 2023 |
Last Verified: | November 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | Following publication, individual patient data will be made available for sharing to researchers with 1) a signed data access agreement, 2) research testing a hypothesis, 3) a protocol that has been approved by an institutional review board, and 4) a proposal that has received approval from the principal investigator. |
Supporting Materials: |
Study Protocol Statistical Analysis Plan (SAP) |
Time Frame: | Following publication. No end date |
Access Criteria: |
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Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Critical illness Emergency airway management Tracheal intubation Non-invasive ventilation Facemask oxygen |
Respiratory Insufficiency Respiration Disorders Respiratory Tract Diseases |