Comparison of Rapid Sequence Intubation Vs Non-Rapid Sequence Intubation in Type 2 Respiratory Failure Secondary to COPD

Abstract

Background: Airway management by rapid sequence intubation (RSI) is the most prevalent emergency endotracheal intubation procedure used in the emergency department to preserve normal respiratory function. Objective: To assess the effectiveness of rapid and non-rapid sequence intubation (RSI vs. non-RSI) in patients presented with type 2 respiratory failure secondary to chronic obstructive pulmonary disease. Methods: A quasi-experimental study was carried out at the emergency department of Ziauddin University Hospital North Campus in Karachi from March 2023 to September 2023. Consecutive sampling was used to recruit 150 adult patients with type 2 respiratory failure related to COPD who were at least 18 years old, in need of endotracheal intubation (ETI) for airway management, had a Glasgow Coma Scale (GCS) of at least 8, and could not tolerate noninvasive ventilation. Patients were randomly grouped into Group A (RSI) and Group B (Non-RSI) and treated according to standard protocol. ETI success or failure and complications during the procedure were documented. Results: Out of 150 enrolled patients, male were 76.0% (n=57) and 78.7% (n=59) and female were 24.0% (n=18) and 21.3% (n=16) with mean age of 60.6 and 62.1 years in RSI and non-RSI group respectively. In most cases the ETI was successful on the first attempt 80.0% (n=60) and 65.3% (n=49) followed by second attempt 13.3% (n=10) and 17.3% (n=13) and difficult attempt 6.7% (n=5) and 17.3% (n=13) in RSI and non-RSI group respectively. Oxygen saturation was improved in 92.0% (n=69) and 80.0% (n=60) and type 2 respiratory failure in 97.3% (n=73) and 89.3% (n=67), whereas complications were reported in 20.0% (n=15) and 34.7% (n=26) in RSI and non-RSI group respectively. Conclusion: RSI is significantly associated with higher first attempt success rates, improved oxygen saturation and type 2 respiratory failure and lower risk of complications.