Using Vasopressor Medication to Support Blood Pressure During Intubation Procedure (RAPID PRESS)

Wright State University

Status and phase: Completed; Phase 3

Conditions: Hypotension on Induction; Respiratory Failure; Anesthesia Intubation Complication; Hypotension and Shock; Intubation Complication

Treatments: Drug: Plasma-lyte; Drug: normal saline; Drug: Lactated Ringers, Intravenous; Drug: Norepinephrine

Study type: Interventional

Funder types: Other

Identifiers

NCT05355974

IRB-2022-43 (Other Identifier)

Details and patient eligibility

About

The purpose of this study is to investigate whether protocolized vasopressor use for patients with normal blood pressure undergoing rapid sequence intubation improves hemodynamic parameters and mitigates adverse events.

The hypothesis is that use of vasopressors during Rapid Sequence Intubation will prevent substantial decreases in blood pressure when compared to normal intravenous fluids.

Full description

Aim: Prevent 25-46 percent reduction in systolic blood pressure associated with rapid sequence intubation with norepinephrine compared to isotonic fluids alone.

Enrollment: 42 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Respiratory Failure Requiring Intubation

Exclusion criteria

• Pregnancy
• Patients intubated during code blue clinical scenarios
• Requiring surgical airway
• Failed intubations
• MAP less than 65 or Systolic Blood Pressure (SBP) less than 90mmHg pre-intubation
• Systolic blood pressure greater than 150mmHg
• Prisoners

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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42 participants in 2 patient groups

Norepinephrine plus Isotonic Fluids

Experimental group

Description:

The treatment group will receive a continuous infusion of norepinephrine at 0.10 mcg/kg/min started 2-5 minutes prior to Rapid Sequence Intubation (assuming normal systolic blood pressure 90-140mmHg) in addition to a standard fluid bolus of Lactated Ringers or Normal Saline or Plasmalyte at 999 mL/hr.

Treatment:

Drug: Norepinephrine

Drug: Lactated Ringers, Intravenous

Drug: Plasma-lyte

Drug: normal saline

Isotonic Fluids

Active Comparator group

Description:

The control group will receive an infusion of Lactated Ringers or Normal Saline or Plasma-Lyte with at least 500 mL at 999 ml/hr 2-5 minutes prior to Rapid Sequence Intubation.

Treatment:

Drug: Lactated Ringers, Intravenous

Drug: Plasma-lyte

Drug: normal saline