Preoxygenation Using End-Tidal Oxygen for Rapid Sequence Intubation in the Emergency Department (The PREOXED Trial) - a Multicentre Stepped Wedge Cluster Randomised Control Trial
Rapid Sequence Intubation (RSI) is a high-risk procedure in the emergency department (ED). Patients are routinely preoxygenated (given supplemental oxygen) prior to RSI to prevent hypoxia during intubation. For many years anaesthetists have used end-tidal oxygen (ETO2) levels to guide the effectiveness of preoxygenation prior to intubation. The ETO2 gives an objective measurement of preoxygenation efficacy. This is currently not available in most EDs. This trial evaluates the use of ETO2 on the rate of hypoxia during intubation for patients in the ED.
• The patient is located in the ED resuscitation bay of the participating centre.
• The planned procedure is orotracheal intubation using a laryngoscope and RSI technique with preoxygenation for patients who are spontaneously breathing.
• The patient is deemed to be at a high risk of hypoxia during RSI as per the treating ED clinician, as defined by:
‣ Any patient requiring any form of oxygen therapy before preoxygenation.
⁃ Any patient with respiratory pathology based on clinical or radiological findings. Including, but not limited to:
∙ Pneumonia, pulmonary oedema, acute respiratory distress syndrome (ARDS), aspiration, pulmonary contusion from trauma, infective exacerbations of known lung disease (e.g. asthma, pulmonary fibrosis, emphysema) or pulmonary embolism (PE)
⁃ Any patient with high oxygen consumption. Including, but not limited to:
∙ Sepsis, Diabetic ketoacidosis, alcohol or drug withdrawal, seizures, thyrotoxicosis
⁃ Any underlying patient condition that may predispose to hypoxemia. Including, but not limited to:
∙ Obesity, pregnancy, underlying lung disease (e.g. asthma, pulmonary fibrosis, emphysema), severe injury- hypovolaemia/haemorrhage.
⁃ or any other patient that the treating clinician has a high concern for hypoxemia during RSI.