{"id":25082,"date":"2024-01-11T04:47:00","date_gmt":"2024-01-10T20:47:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25082"},"modified":"2024-01-11T05:55:17","modified_gmt":"2024-01-10T21:55:17","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%80%a5%e6%80%a7%e4%b8%ad%e6%af%92%e6%98%8f%e8%bf%b7%e6%82%a3%e8%80%85%e7%9a%84%e6%97%a0%e5%88%9b%e6%b0%94%e9%81%93%e7%ae%a1%e7%90%86","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25082","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u6025\u6027\u4e2d\u6bd2\u660f\u8ff7\u60a3\u8005\u7684\u65e0\u521b\u6c14\u9053\u7ba1\u7406"},"content":{"rendered":"\n

Original Investigation\u00a0 Caring for the Critically Ill Patient<\/p>\n\n\n\n

November 29, 2023<\/p>\n\n\n\n

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial<\/h1>\n\n\n\n

Yonathan\u00a0Freund,\u00a0Damien\u00a0Viglino,\u00a0Marine\u00a0Cachanado,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online November 29, 2023. doi:10.1001\/jama.2023.24391<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  In patients with suspected poisoning and Glasgow Coma Scale score less than 9, is a conservative airway strategy of withholding intubation associated with a reduction of death, intensive care unit length of stay, and hospital length of stay compared with routine practice?<\/p>\n\n\n\n

Findings<\/strong>  In this multicenter, randomized clinical trial that included 225 patients, a strategy of withholding intubation was associated with a significant clinical benefit for the primary end point in the intervention group, with a win ratio of 1.85 and a reduced adverse event risk rate (6% vs 14.7%; absolute risk difference, 8.6%) compared with the control group.<\/p>\n\n\n\n

Meaning<\/strong>  Among comatose patients with suspected acute poisoning, a conservative strategy of withholding intubation was associated with a greater clinical benefit for the composite end point of in-hospital death, length of intensive care unit stay, and length of hospital stay.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Tracheal intubation is recommended for coma patients and those with severe brain injury, but its use in patients with decreased levels of consciousness from acute poisoning is uncertain.<\/p>\n\n\n\n

Objective<\/strong>  To determine the effect of intubation withholding vs routine practice on clinical outcomes of comatose patients with acute poisoning and a Glasgow Coma Scale score less than 9.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This was a multicenter, randomized trial conducted in 20 emergency departments and 1 intensive care unit (ICU) that included comatose patients with suspected acute poisoning and a Glasgow Coma Scale score less than 9 in France between May 16, 2021, and April 12, 2023, and followed up until May 12, 2023.<\/p>\n\n\n\n

Intervention<\/strong>  Patients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was a hierarchical composite end point of in-hospital death, length of ICU stay, and length of hospital stay. Key secondary outcomes included adverse events resulting from intubation as well as pneumonia within 48 hours.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among the 225 included patients (mean age, 33 years; 38% female), 116 (16%) were in the intervention group and 109 (58%) in the control group. No patients died during the in-hospital stay. There was a significant clinical benefit for the primary end point in the intervention group, with a win ratio of 1.85 (95% CI, 1.33 to 2.58). In the intervention group, there was a lower proportion with any adverse event (6% vs 14.7%; absolute risk difference, 8.6% [95% CI, \u221216.6% to \u22120.7%]) compared with the control group, and pneumonia occurred in 8 (6.9%) and 16 (14.7%) patients, respectively (absolute risk difference, \u22127.8% [95% CI, \u221215.9% to 0.3%]).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among comatose patients with suspected acute poisoning, a conservative strategy of withholding intubation was associated with a greater clinical benefit for the composite end point of in-hospital death, length of ICU stay, and length of hospital stay.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04653597<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation\u00a0 Caring for the Critically Ill P […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25082"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25082"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25082\/revisions"}],"predecessor-version":[{"id":25085,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25082\/revisions\/25085"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25082"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25082"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25082"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}