Atrium Health Wake Forest Baptist is participating in a national study to determine a best practice for how to place a severely ill patient on a breathing machine.
About 2,400 patients will be enrolled in the study that begins in March with Vanderbilt University Medical Center as another primary participants, along with University of Colorado at Anschutz, Denver Health Medical Center, Hennepin County Medical Center and University of Alabama at Birmingham.
According to the medical centers, one in four severely ill patients undergoing intubation in an emergency department or intensive care unit experiences serious problems with blood pressure or oxygen levels during this procedure.
Most patients requiring intubation in those settings are unconscious or in distress.
“There is often no time for doctors to discuss the risks and benefits of the procedure with the patient,” according to the news release. “Physicians typically must go ahead with life-saving care without the patient’s consent.
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“For these same reasons, doctors may not be able to get a patient’s consent to take part in the RSI study.”
Researchers are trying to determine what risk levels there are involving the sedative medication used during the procedure. The initial study commenced in April 2022.
The two most commonly used sedatives are ketamine and etomidate.
Both are approved by the Food and Drug Administration, and have been in use for decades.
However, it is not known whether one drug is better for patients overall, or for patients with specific medical problems.
Researchers will look to determine whether ketamine or etomidate is better for preventing low blood pressure, low oxygen levels, serious heart problems, or even death for severely ill patients undergoing intubation.
The choice between the two drugs will be made once it is determined that ketamine and etomidate would be equally effective for the patient.
“Determining which of these two commonly used medications is best could improve care for tens of thousands of the sickest patients every year,” said Dr. Kevin Gibbs, who is leading the Baptist study initiative and is an associate professor of pulmonary and critical care medicine at Wake Forest University School of Medicine.
Researchers meet with each patient or family member after the procedure has been completed to discuss the study.
The study is funded by the Patient-Centered Outcomes Research Institute. For more information, go to www.pragmaticcriticalcare.org/current-trials/rsi-patient-information/.
