EBM - FELLOW Trial

Background

The Facilitating Endotracheal intubation by Laryngoscopy technique and apnoeic Oxygenation Within the intensive care unit (FELLOW) Trial

American Journal of Respiratory Critical Care Medicine, 2015-10-01

Q: Does administration of supplementary O2 during laryngoscopy prevent hypoxaemia

Randomised, open-label, pragmatic trial.

150 adults undergoing endotracheal intubation in ICU

➤ Two arms:

Apnoeic oxygenation
- i.e. 15 L/min 100% O2 via high-flow nasal cannula during laryngoscopy
Usual care
- i.e. No supplementary O2 during laryngoscopy

➤ Primary outcome:

No statistically significant difference between the two groups.

Specifically,

Median lowest SaO2 was 92% in apnoeic oxygenation group, and 90% in usual care group. p = 0.16
No difference in the incidence of:
- SaO2 < 90% (44.7% vs 47.2%, p = 0.87)
- SaO2 < 80% (15.8% vs 25%, p = 0.22)
- Desaturation, i.e. drop in SaO2 more than 3% (53.9% vs 55.6%, p = 0.87)
No difference in duration of mechanical ventilation, length of ICU stay, and in-hospital mortality

Possible selection bias due to exclusion criteria (e.g. emergency intubation, doctor wanted a specific approach)
Not double-blinded
Small single centre study
While no benefit is proven for apnoeic oxygenation, there is also no harm proven

Reference:

2015-10-31