Withholding intubation clinically beneficial among comatose patients with suspected acute poisoning: JAMA

Coma or Comatose stage is characterized as a lengthy deep state of unconsciousness. People in a state of coma are alive but are unable to move or be aware of or respond to their surroundings. They lose their thinking abilities but retain non-cognitive function and normal sleep patterns. Acute poisoning caused by alcohol, drugs, or medication is a common non traumatic reason for a decreased level of consciousness and is often associated with a high rate of intubation.

Comatose patients with suspected acute poisoning, a conservative strategy of withholding intubation was associated with a greater clinical benefit for the composite end point of in-hospital death, length of intensive care unit stay, and length of hospital stay according to a study published in JAMA Network.

Researchers conducted a multicenter, randomized trial in 20 emergency departments and 1 intensive care unit (ICU) that included comatose patients with suspected acute poisoning and a Glasgow Coma Scale score less than 9 in France. Patients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice. The primary outcome was a hierarchical composite end point of in-hospital death, length of ICU stay, and length of hospital stay. Key secondary outcomes included adverse events resulting from intubation as well as pneumonia within 48 hours.