Holding Off on Intubation for Airway Protection After a Toxic Ingestion

Many patients who present to the emergency department with decreased level of consciousness after a toxic ingestion are intubated for “airway protection” to lower risk for aspiration. In situations where relatively rapid clearance occurs and alertness improves, intubation might be unnecessary.

French investigators randomized 225 patients with acute poisoning and decreased level of consciousness (Glasgow Coma Scale, <9) to one of two groups. In one group, intubation was withheld unless seizure, respiratory distress, vomiting, or shock developed. In the other group, intubation was optional and at the emergency medicine physician's discretion. Patients were monitored closely for 4 hours after randomization and then all were treated with usual c…