Recommendation for high flow nasal cannula oxygen therapy order set for Intubations

1
Effectiveness
1
Safety
Vanderbilt University Medical Center, Nashville, TN
+1 More
Recommendation for high flow nasal cannula oxygen therapy order set - Other
Eligibility
18+
All Sexes
Eligible conditions
Intubations

Study Summary

This study is evaluating whether a new oxygen delivery system may help reduce the number of times a patient needs to be intubated.

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Eligible Conditions

  • Intubations
  • Cardiovascular Surgical Procedures

Treatment Effectiveness

Effectiveness Estimate

1 of 3

Study Objectives

This trial is evaluating whether Recommendation for high flow nasal cannula oxygen therapy order set will improve 1 primary outcome and 3 secondary outcomes in patients with Intubations. Measurement will happen over the course of hospital discharge (usually 14 days).

48 hours
Reintubation within 48 hours of extubation
72 hours
Reintubation within 72 hours of extubation
Day 14
In-hospital mortality
Reintubation after cardiac surgery

Trial Safety

Safety Estimate

1 of 3

Trial Design

2 Treatment Groups

Provider Choice Standard Care
High Flow Nasal Canula Oxygen Therapy

This trial requires 3192 total participants across 2 different treatment groups

This trial involves 2 different treatments. Recommendation For High Flow Nasal Cannula Oxygen Therapy Order Set is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

High Flow Nasal Canula Oxygen Therapy
Other
Participants will be assigned post extubation physician order set which recommends the administration of oxygen therapy via HFNC. HFNC is a heated and humidified system that allows prescribed fraction of inspired oxygen (FIO2) levels to be delivered at very high flow rates.
Provider Choice Standard Care
Other
Participants be assigned standard provider choice of standard care therapy physician order set.

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: 72 hours
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly 72 hours for reporting.

Who is running the study

Principal Investigator
R. F.
Prof. Robert Freundlich, Assistant Professor of Anesthesiology and Biomedical Informatics
Vanderbilt University Medical Center

Closest Location

Vanderbilt University Medical Center - Nashville, TN

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 3 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
The patient was extubated at some point following arrival in the Cardiovascular Intensive Care Unit show original
(CVICU), the patient was noted to have a severe tracheal stenosis show original
were randomized to receive one of two interventions: usual care (n = 214) or daily telephone-delivered motivational interviewing (MI, n = 209) show original

Patient Q&A Section

Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

What are the signs of intubations?

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Intubation in children is most often carried out as the consequence of accidents while attempting to obtain a tracheoscope. The most typical indications for intubation in children are as follows: inability to eat, and a lack of activity, especially the inability to sleep. In infants, indications for intubations are as follows: cardiorespiratory arrest, lack of feeding, respiratory failure, and a lack of movement.

Unverified Answer

Can intubations be cured?

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Intubations are not a cure for [lung cancer](https://www.withpower.com/clinical-trials/lung-cancer). Intubations, often done as a routine in the first week after an operation, do not appear to prevent a cancer relapse. This could be because of a poor response to an operation in lung cancer, rather than an operation being bad by itself. The long term effect of intubations may be a greater effect on cancer relapse and treatment. It may be best to check the patient, and if there is relapse to re-intubate again.

Unverified Answer

What are common treatments for intubations?

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Tracheal intubations are commonly required in many areas for treatment of respiratory arrest or bronchopleural emphysema. Complications are relatively infrequent and usually minor. In most cases, laryngoscopy, cuffed or wire-assisted tracheal intubation, and rapid sequence induction (RSi) procedures are used for the procedure.

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How many people get intubations a year in the United States?

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[In the United States in 2011, 20,650 people received an intubation in the hospital.[1] The majority (57%) received the procedure during hospitalization (see table, below)]intubations can occur outside of the hospital (i.e., at home or in the field).[2] Most intubations are performed by internists or pulmonologists or both according to a patient's specific circumstances. The vast majority of intubations (95%) are performed without anesthesia, because of non-medically necessary reasons or when the patient has no medical requirement for an intubation (e.g., for an endotracheal tube).

Unverified Answer

What causes intubations?

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The airway is a critical site for a wide variety of infections. The intubation of patients with upper airway pathology is often complicated by these opportunists. Appropriate infection control practices are essential to ensure the success of such procedures.

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What is intubations?

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The first, and primary, goal of airway management is to clear secretions and permit secure endotracheal and nasopharyngeal tube placement in a patient with a decreased level of consciousness. The most common complications of airway management include tracheomalacia, ventilator mediated pneumonia, and hypoxia. Tracheal tube insertion in children and adults may sometimes be done with greater success. In most cases, however, the first line is still mechanical ventilation for airway management. Many patients on a mechanical ventilator are transferred, for various reasons, to an ICU bed to continue mechanical ventilator support.

Unverified Answer

What are the common side effects of recommendation for high flow nasal cannula oxygen therapy order set?

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Based on our experience patients experienced a variety of side effects related to using a high flow nasal cannula. Many of these side effects are predictable however some of these side effects could lead to a higher level of anxiety. Findings from a recent study suggests the need for more education on the use of high flow nasal cannula oxygen therapy and the need for the development of order sets that will reduce some of these side effects.

Unverified Answer

What does recommendation for high flow nasal cannula oxygen therapy order set usually treat?

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There is wide variation in how high flow nasal cannulae oxygen therapy (HFNCO2) is recommended after uncomplicated mechanical ventilation and/or respiratory/bronchoscopic intervention. Recommendations for supplemental oxygen in some patients may result in lower oxygen saturations than currently utilized in other patients.

Unverified Answer

What is the latest research for intubations?

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The last few years have seen an increase in the number of new studies in intubations that have been carried out by various medical specialities. These improvements have been spurred by a focus to use a less invasive intervention to minimize post-intubation complications. At the same time, there has also been an increase in the research in to use less invasive methods of intubating, which have come into being through the use of the videolaryngoscope and also from new models of laryngoscopes that enable an easier and more effective approach to intubation.

Unverified Answer

What is the average age someone gets intubations?

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Intubation in adults is associated with a wide range of age (24 years to 93 years), gender, and indications. This information should assist with the planning of an intubation plan.

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Have there been other clinical trials involving recommendation for high flow nasal cannula oxygen therapy order set?

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While we are aware of no other high profile trial for oxygen therapy using the FNC, we did not have any other study showing that HFNC is beneficial for people with ARDS.

Unverified Answer

Is recommendation for high flow nasal cannula oxygen therapy order set typically used in combination with any other treatments?

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Despite previous experience, the authors found inconsistencies within the protocols regarding the use of HFNCO2. Although it was often recommended by physicians, they rarely (or never) prescribed these devices themselves in conjunction with treatments. We believe that this practice is in need of standardized guidelines.

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