NIV of comatose patients with acute poisoning: The NICO Trial
Apr 03, 2024
The CASE
A 28 yo patient is brought in by ambulance with a depressed conscious state. The ambulance was called by friends who give a history of the patient drinking all night. There is no known other substances.
On arrival:
- GCS 8
- Afebrile
- HR 98bpm,
- BP 136/62
- Saturations 97% on room air.
Would you intubate this patient?
What if the GCS was 5 or 6?
In days gone by, due to the depressed conscious state and the uncertainty of other substances, we would, in most cases opt for intubating this patient, to secure the airway avoiding the risks of aspiration. Should we? Are creating more potential problems?
I must admit that in pure intoxication, if the patient can be nursed appropriately(resource problem), I would hold off on intubation. However if there was any other substance involved, or there was a risk of intracranial injury (which is difficult to pick), I would intubate.
Along comes the NICO Trial (1) (Non-invasive Airway Management of Comatose Poisoned Emergency Patients).
Question They Asked
“In patients with suspected poisoning and Glasgow Coma Scale score less than 9, is a conservative airway strategy of withholding intubation associated with a reduction of death, intensive care unit length of stay, and hospital length of stay compared with routine practice?”
What They Did
This was a multicentre study(20 Emergency Departments and 1 ICU in France)....
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