Best Way to Place Patients on Studied Respirators | Journalist VUMC

by Kylie Avery

The procedure of placing a critically ill patient on an artificial respirator (intubation) can be high risk. One in four critically ill patients undergoing intubation in the emergency department or intensive care unit experience serious problems with blood pressure or oxygen levels during this procedure.

Some of these risks may be related to drugs used during the procedure to make the patient drowsy (a sedative). The two drugs that doctors give most often in this situation are ketamine and etomidate. Both are approved by the U.S. Food and Drug Administration (FDA) and have been used for decades, but it’s unclear if one drug is better for patients, overall, or for patients with problems specific medical.

Beginning April 4, Vanderbilt suppliers launched the “Randomized Trial of Sedative Choice for Intubation” (RSI) study to determine whether ketamine or etomidate are better for preventing low blood pressure, low levels of oxygen, serious heart problems or even death in seriously ill people. patients undergoing intubation.

Approximately 1,900 patients will be enrolled. During the study, when providers are caring for a critically ill patient in the emergency department or Vanderbilt intensive care unit who needs to be placed on a breathing machine, and they suspect that ketamine and etomidate would be equally effective for this patient, the choice between the two will be made by the RSI study.

“Knowing whether the two drugs are the same for patients, or whether one is better, could improve care for tens of thousands of patients each year,” says Jonathan Casey, MD, assistant professor of allergy, medicine pulmonary and intensive care unit, who is leading the study.

“Determining which of these two commonly used drugs is better will help physicians better manage the sickest patients during this life-saving emergency procedure,” said Matthew Semler, MD, assistant professor of allergy, pulmonary and critical care medicine.

Placing critically ill patients on life support is an emergency procedure. Most patients requiring intubation in the emergency department or intensive care unit are unconscious or in distress. Doctors often don’t have time to discuss the risks and benefits of the procedure with the patient. Doctors usually have to provide life-saving care without the patient’s consent.

For these same reasons, physicians may not be able to obtain consent from a patient to participate in the RSI study. Important research to find the best care for life-threatening conditions, like the RSI study, is therefore conducted through a process called “Exception from Informed Consent” (EFIC), in which the study is overseen by the FDA and a committee independent ethics committee, and researchers meet with each patient or family member after the procedure is complete to discuss the study.

VUMC researchers, in addition to Casey and Semler, include Kevin Seitz, MD, and Todd Rice, MD, in the Division of Allergy, Pulmonary, and Critical Care Medicine; and Wesley Self, MD, Jin Ho Han, MD, Aaron Lacy, MD, and Graham Van Schaik, MD, from the Department of Emergency Medicine. The study is supported by grant K23-HL153584 from the National Heart, Lung, and Blood Institute.

James G. Williams