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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: Faheem Ahmed Khan
Chua, Mui Teng
Ng, Wei Ming
Lu, Qingshu
Low, Matthew Jian Wen
Yau, Ying Wei
Punyadasa, Amila
Kuan, Win Sen
Keywords: Rapid Sequence Intubation
High Flow Nasal Oxygenation
Issue Date: 2019
Source: Chua, M. T., Faheem Ahmed Khan, Ng, W. M., Lu, Q., Low, M. J. W., Yau, Y. W., . . . Kuan, W. S. (2019). 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, 195-. doi:10.1186/s13063-019-3305-8
Series/Report no.: Trials
Abstract: 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 15L/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.
DOI: 10.1186/s13063-019-3305-8
Rights: © 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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