The codes were concealed in an opaque envelope which was opened up by the nursing officer before airway management. Patients were randomized 1:1 to RSI or DSI groups via computer-generated random number codes. This was a randomized control trial at a level two trauma center in Chandigarh, India. DSI has previously been studied in observational trials with ED patients (both medical and surgical) with improvements in mean O 2 saturation from 89.9% to 98.8% after DSI, 4 and it was hypothesized by these authors that these benefits may transfer to trauma patients requiring emergent airway management. The advantage over RSI is that this dose of ketamine relieves agitation and pain while maintaining spontaneous respirations and airway reflexes. 3ĭelayed sequence intubation (DSI) involves administering a dissociative dose of ketamine followed by goal-directed preoxygenation for a minimum of 3 minutes, neuromuscular blocker administration, and intubation. Other peri-intubation adverse events have been reported like hemodynamic instability, direct airway trauma, and vomiting with or without pulmonary aspiration. 2 This hypoxia can result in secondary injuries and worse outcomes, especially in trauma patients with associated head injury. Thus, adequate preoxygenation is often not achieved and a higher incidence of peri-intubation desaturation has been reported. For the agitated or combative patients who do not tolerate pre-oxygenation, positive pressure ventilation with a bag valve mask (BVM) before intubation can be trialed however, this can worsen the risk of gastric distension or aspiration and is often not tolerated by trauma patients either. 1 The pre-oxygenation step is critical since it allows for denitrogenation of the lungs and increases the oxygen content of functional reserve capacity, both creating a physiologic reserve that prevents hypoxia in the apneic phase of intubation. Many clinicians prefer rapid sequence intubation (RSI), which involves pre-oxygenation followed by near-simultaneous administration of an induction agent and a neuromuscular blocker to facilitate intubation without transitional ventilation. In addition, trauma patients may be agitated and delirious due to pain, altered mental status, and hypoxia. Securing a definitive airway in trauma patients is daunting due to trauma-induced factors such as airways contaminated by blood or vomit as well as faciomaxillary, cervical spine, and head injuries. To compare the incidence of peri-intubation hypoxia after delayed versus rapid sequence intubation in critically injured trauma patients Peri-Intubation Hypoxia After Delayed Versus Rapid Sequence Intubation in Critically Injured Patients on Arrival to Trauma Triage: A Randomized Controlled Trial. ARTICLE: Bandyopadhyay A, Kumar P, Jafra A, Thakur H, Yaddanapudi LN, Jain K.
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