Methodology: 3.5/5
Usefulness: 3/5
Freund Y, et al. JAMA. 2023 Dec 19;330(23):2267-2274.
Question and Methods: Multicenter RCT involving comatose patients with suspected acute poisoning and GCS <9 compared a conservative airway strategy of withholding intubation versus routine practice for the primary hierarchical composite end point of in-hospital death, length of ICU stay, and length of hospital stay.
Findings: N=225 patients. No patients died in the trial. There was a clinical benefit for the primary composite end point of in-hospital death, length of ICU stay, and length of hospital stay in the intervention group, with a win ratio of 1.85 (95% CI, 1.33-2.58, p<0.001).
Limitations: The major limitations of the study include lack of blinding, small sample size, emphasis on GCS score, and no events of death in the composite primary endpoint.
Interpretation: This randomized trial supports our current practice patterns such that a conservative strategy of withholding intubation may be beneficial for comatose patients with suspected acute poisoning.
By: Dr. Brenton Wong
JC Supervisor: Dr. Krishan Yadav
