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Title: Pre- and Apnoeic high flow oxygenation for RApid sequence intubation in The Emergency department (Pre-AeRATE): study protocol for a multicentre, randomised controlled trial
Authors: Chua, Mui Teng 
Khan, Faheem Ahmed
Ng, Wei Ming
Lu, Qingshu
Low, Matthew Jian Wen
Yau, Ying Wei 
Punyadasa, Amila
Kuan, Win Sen 
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, Research & Experimental
Research & Experimental Medicine
Rapid sequence intubation
High flow nasal oxygenation
Apnoeic oxygenation
Issue Date: 4-Apr-2019
Publisher: BMC
Citation: Chua, Mui Teng, Khan, Faheem Ahmed, Ng, Wei Ming, Lu, Qingshu, Low, Matthew Jian Wen, Yau, Ying Wei, Punyadasa, Amila, Kuan, Win Sen (2019-04-04). Pre- and Apnoeic high flow oxygenation for RApid sequence intubation in The Emergency department (Pre-AeRATE): study protocol for a multicentre, randomised controlled trial. TRIALS 20 (1). ScholarBank@NUS Repository.
Abstract: © 2019 The Author(s). Background: Maintaining adequate oxygenation during rapid sequence intubation (RSI) is imperative to prevent peri-intubation adverse events that can lead to increased duration of hospital and intensive care unit stay, or a prolonged vegetative state requiring long-term institutionalisation. Despite employing current best practices during RSI, desaturation during intubation still occurs. High-flow nasal cannula (HFNC) oxygenation may potentially improve oxygenation during pre- and apnoeic oxygenation to allow a longer safe apnoeic time for RSI. Objective: We aim to test the hypothesis that the use of humidified high-flow oxygenation via nasal cannula at 60 L/min maintains higher oxygen saturation compared with current usual care of non-rebreather mask and standard nasal cannula at an oxygen flow rate of 15 L/min for pre- and apnoeic oxygenation. Methods: This is a multi-centre randomised controlled trial enrolling adult patients aged 21 years and older who require rapid sequence intubation due to medical, surgical, or traumatic conditions in the Emergency Departments (EDs) of the National University Hospital and the Ng Teng Fong General Hospital. Eligible patients will undergo randomisation at an equal ratio into intervention or control arms. The primary endpoint will be the lowest oxygen saturation achieved during the first intubation attempt from time of administration of paralytic agent until quantitative end-tidal carbon dioxide is detected if the first intubation attempt is successful, or until the start of the second attempt if it is not. Discussion: Prolongation of safe apnoea time through maintenance of oxygen saturation above 90% using HFNC oxygenation during RSI could potentially change current clinical practice, improve standard of care, and translate to better outcomes for patients. Trial registration:, NCT03396094. Registered on 10 January 2018.
Source Title: TRIALS
ISSN: 1745-6215
DOI: 10.1186/s13063-019-3305-8
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