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

 


 

Authors

  • Dr. Brenton Wong

    Dr. Brenton Wong is a PGY-3 in the uOttawa CCFP-EM program.

    View all posts
  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

    View all posts
  • Dr. Krishan Yadav is an FRCPC Emergency Medicine Physician, and Epidemiologist with a special interest in non-purulent skin and soft tissue infectious disease.

    View all posts