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Is endotracheal intubation a non-beneficial treatment in patients with respiratory failure due to paraquat poisoning?

ABSTRACT: Paraquat poisoning can result in dysfunction of multiple organs, and pulmonary fibrosis with respiratory failure is the major cause of mortality. For terminally ill patients, some life-prolonging treatments can be non-beneficial treatments (NBT). The objective of this study was to determine if intubation is a NBT for patients with respiratory failure due to paraquat poisoning.The study included 68 patients with respiratory failure due to paraquat poisoning. Patients were hospitalized at MacKay Memorial Hospital, Taitung Branch, Taiwan, between 2005 to April 2016. Composite outcomes of intra-hospital mortality, the rate of do-not-resuscitate (DNR) orders, prescribed medications, length of stay, and medical costs were recorded and compared between the do-not-intubate (DNI) group and endotracheal intubation (EI) group.Intra-hospital mortality rate for the entire population was 100%. There were significantly more patients with DNR orders in the DNI group (P = 0.007). There were no differences in the length of hospital stay. However, patients in DNI group had significantly less vasopressor use and more morphine use, shorter time in the intensive care unit, and fewer medical costs.The procedure of intubation in patients with respiratory failure due to paraquat poisoning can be considered inappropriate life-prolonging treatment.

SUBMITTER: Wu MR

PROVIDER: S-EPMC5874070 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Is endotracheal intubation a non-beneficial treatment in patients with respiratory failure due to paraquat poisoning?

Wu Meng-Ruey MR Hsiao Chia-Ying CY Cheng Chun-Han CH Liao Feng-Ching FC Chao Chuan-Lei CL Chen Chun-Yen CY Yeh Hung-I HI Su Min-I MI

PloS one 20180328 3

<h4>Introduction</h4>Paraquat poisoning can result in dysfunction of multiple organs, and pulmonary fibrosis with respiratory failure is the major cause of mortality. For terminally ill patients, some life-prolonging treatments can be non-beneficial treatments (NBT). The objective of this study was to determine if intubation is a NBT for patients with respiratory failure due to paraquat poisoning.<h4>Methods</h4>The study included 68 patients with respiratory failure due to paraquat poisoning. P ...[more]

PMID: 29590187

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Project description:OBJECTIVES:Teleguidance facilitated intubation has recently reemerged during the coronavirus disease 2019 pandemic as a strategy to provide expert airway management guidance and consultation to practitioners in settings where such expertise is not readily available onsite or in-person. We conducted a scoping review to provide a synthesis of the available literature on teleguidance facilitated intubation. Specifically, we aimed to evaluate the feasibility, safety, and efficacy of teleguidance facilitated intubation given existing technology. DATA SOURCES:A librarian-assisted search was performed using three primary electronic medical databases from January 2000 to November 2020. STUDY SELECTION:Articles that reported outcomes focused on implementing or evaluating the performance of teleguidance facilitated intubation were included. DATA EXTRACTION:Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system. DATA SYNTHESIS:Of 255 citations identified, 17 met eligibility criteria. Studies included prospective investigations and proof of technology reports. These studies were performed in clinical and simulation environments. Five of the prospective investigations that examined time to intubation and intubation success rates. Multiple different commercially available and noncommercial teleconference software systems were used in these studies. CONCLUSIONS:There is a limited body of literature evaluating the feasibility, safety, and efficacy of teleguidance facilitated intubation. Based on the studies available that examined a variety of technologies within simulation and clinical environments, teleguidance facilitated intubation appears to be feasible, safe, and efficacious. Given the exponential growth in the use of telemedicine technology during the coronavirus disease 2019 pandemic and the evidence supporting teleguidance facilitated intubation, there is a need to critically evaluate the most effective mechanisms to integrate and optimize these technologies across diverse practice settings.

Project description:ImportanceEndotracheal intubation and mechanical ventilation are life-saving treatments for acute respiratory failure but are complicated by significant rates of dyspnea and dysphonia after extubation. Unilateral vocal fold immobility (UVFI) after extubation can alter respiration and phonation, but its incidence, risk factors, and pathophysiology remain unclear.ObjectivesTo determine the incidence of UVFI after prolonged (>12 hours) mechanical ventilation in a medical intensive care unit and investigate associated clinical risk factors for UVFI after prolonged mechanical ventilation.Design, setting, and participantsThis subgroup analysis of a prospective cohort study was conducted in a single-center medical intensive care unit from August 17, 2017, through May 31, 2018, among 100 consecutive adult patients who were intubated for more than 12 hours. Patients were identified within 36 hours of extubation and recruited for study enrollment. Those with an established tracheostomy prior to mechanical ventilation, known laryngeal or tracheal pathologic characteristics, or a history of head and neck radiotherapy were excluded.ExposureInvasive mechanical ventilation via an endotracheal tube.Main outcomes and measuresThe incidence of UVFI as determined by flexible nasolaryngoscopy.ResultsOne hundred patients (62 men [62%]; median age, 58.5 years [range, 19.0-87.0 years]) underwent endoscopic evaluation after extubation. Seven patients had UVFI, of which 6 cases (86%) were left sided. Patients with hypotension while intubated (odds ratio [OR], 10.8; 95% CI, 1.6 to ∞), patients requiring vasopressors while intubated (OR, 16.7; 95% CI, 2.4 to ∞), and patients with a preadmission diagnosis of peripheral vascular disease (OR, 6.2; 95% CI, 1.2-31.9) or coronary artery disease (OR, 5.1; 95% CI, 1.0-25.5) were more likely to develop UVFI.Conclusions and relevanceUnilateral vocal fold immobility occurred in 7 of 100 patients in the medical intensive care unit who were intubated for more than 12 hours. Unilateral vocal fold immobility was associated with inpatient hypotension and preadmission vascular disease, suggesting that ischemia of the recurrent laryngeal nerve may play a role in disease pathogenesis.

Project description:Background:Endotracheal suctioning (ETS) is a common procedure in intubated patients for the clearance of secretions and improvement of oxygenation. Objectives:Owing to the controversies in previous studies, we studied the effects of open ETS before surgery on respiratory parameters in children with pulmonary crackles. Methods:In this clinical trial, 100 children with pulmonary crackles, candidates for surgery were randomly assigned into two groups. After intubation, in the group A (n = 50), deep and open suction was done until the crackle was cleared and in the group B (n = 50), anesthesia without suctioning was continued. Hemodynamic and respiratory parameters were compared. Results:The patients in group A had higher oxygen saturation with a statistically significant difference in 15th to 75th minutes of the operation (P < 0.001) and in post-anesthetic care unit (P = 0.004). After suction, before and after extubation, there was a statistically significant reduction of crackles in the group A in comparison to the group B (P < 0.001). There was no statistically significant difference in the end-tidal CO2, airway pressure and respiratory rate between the two groups (P > 0.05). Relevant complications and the emergence of anesthesia time were statistically lower in the group A (P < 0.001). There was no statistically significant change in terms of blood pressure in the two groups (P > 0.05). The heart rate in the 15th, 30th, and 45th minutes of surgery was statistically lower in the group B (P < 0.05). Conclusions:This study indicates positive effects of open and deep suction in improving oxygen saturation and reducing complications and emergence time. Pulmonary auscultation of the group A before and after weaning was statistically better than group B. However, this study found no positive effect of ETS on airway pressure, ETCO2, blood pressure, and respiratory rate. Meanwhile, increased heart rate in the group A might introduce the potential risk of dysrhythmia and hemodynamic instability.

Project description:Previous studies suggest improved patient outcomes for providers who perform high volumes of complex medical procedures. Out-of-hospital tracheal intubation is a difficult procedure. We seek to determine the association between rescuer procedural experience and patient survival after out-of-hospital tracheal intubation.We analyzed probabilistically linked Pennsylvania statewide emergency medicine services, hospital discharge, and death data of patients receiving out-of-hospital tracheal intubation. We defined tracheal intubation experience as cumulative tracheal intubation during 2000 to 2005; low=1 to 10 tracheal intubations, medium=11 to 25 tracheal intubations, high=26 to 50 tracheal intubations, and very high=greater than 50 tracheal intubations. We identified survival on hospital discharge of patients intubated during 2003 to 2005. Using generalized estimating equations, we evaluated the association between patient survival and out-of-hospital rescuer cumulative tracheal intubation experience, adjusted for clinical covariates.During 2003 to 2005, 4,846 rescuers performed tracheal intubation. These individuals performed tracheal intubation on 33,117 patients during 2003 to 2005 and 62,586 patients during 2000 to 2005. Among 21,753 cardiac arrests, adjusted odds of survival was higher for patients intubated by rescuers with very high tracheal intubation experience; adjusted odds ratio (OR) versus low tracheal intubation experience: very high 1.48 (95% confidence interval [CI] 1.15 to 1.89), high 1.13 (95% CI 0.98 to 1.31), and medium 1.02 (95% CI 0.91 to 1.15). Among 8,162 medical nonarrests, adjusted odds of survival were higher for patients intubated by rescuers with high and very high tracheal intubation experience; adjusted OR versus low tracheal intubation experience: very high 1.55 (95% CI 1.08 to 2.22), high 1.29 (95% CI 1.04 to 1.59), and medium 1.16 (95% CI 0.97 to 1.38). Among 3,202 trauma nonarrests, survival was not associated with rescuer tracheal intubation experience; adjusted OR versus low tracheal intubation experience: very high 1.84 (95% CI 0.89 to 3.81), high 1.25 (95% CI 0.85 to 1.85), and medium 0.92 (95% CI 0.67 to 1.26).Rescuer procedural experience is associated with improved patient survival after out-of-hospital tracheal intubation of cardiac arrest and medical nonarrest patients. Rescuer procedural experience is not associated with patient survival after out-of-hospital tracheal intubation of trauma nonarrest patients.

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Is endotracheal intubation a non-beneficial treatment in patients with respiratory failure due to paraquat poisoning?

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Is endotracheal intubation a non-beneficial treatment in patients with respiratory failure due to paraquat poisoning?

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