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Delayed Sequence IntubationDSI vs RSINCT07380763

Comparison of Peri-intubation Oxygenation Values and Complications in Patients Intubated With the Delayed Versus Rapid Sequence Intubation Protocols

A study testing Delayed Sequence Intubation and Rapid Sequence Intubation in people with Delayed Sequence Intubation and Rapid Sequence Induction and Intubation, run by Kanuni Sultan Suleyman Training and Research Hospital at 4 sites in Turkey (Türkiye).

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study compares two different methods of helping patients breathe by placing a tube in their airway (intubation) in an emergency setting. These methods are called Rapid Sequence Intubation (RSI) and Delayed Sequence Intubation (DSI). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Delayed Sequence Intubation and Rapid Sequence Intubation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
140 participants
Where
4 sitesTurkey (Türkiye)
Study dates
29 Oct 2025to 29 Jun 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged 18 years or older
  • Presence of spontaneous breathing.
  • No prediction of a difficult airway prior to intubation.
  • Requirement for advanced airway management.
  • Not in cardiac arrest.
  • Decided to intubate due to non-traumatic etiologies.
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  • Planned intubation using ketamine for sedation and rocuronium for paralysis.
  • Decision to intubate due to one of the following clinical conditions:
  • Acute Respiratory Failure: Patients with hypoxic or hypercapnic respiratory failure where adequate oxygenation cannot be achieved despite non-invasive ventilation.
  • Inability to Protect the Airway: Altered level of consciousness or increased risk of pulmonary aspiration due to conditions such as upper gastrointestinal bleeding, ileus, volvulus, gastric outlet obstruction, hypersalivation, or hyperemesis.
  • Shock States: Patients in any state of shock (hypovolemic, distributive, cardiogenic, obstructive) exhibiting severe altered mental status or declining respiratory status.
  • Neuroprotection: Need to terminate ongoing seizures resistant to medical therapy (status epilepticus), or situations requiring strict control of arterial carbon dioxide (PaCO₂) levels to manage increased intracranial pressure (ICP) in non-traumatic conditions (such as intracranial hemorrhage or severe encephalopathy).
  • Obtaining informed consent from the patient or their legally authorized representative.

Who cannot join

  • Aged under 18 years.
  • Pregnancy.
  • Refusal to provide informed consent.
  • Cardiac arrest prior to intubation.
  • Anticipated difficult airway.
  • Intubation required due to traumatic etiologies.
Show all 11Show fewer
  • Missing or incomplete patient data.
  • Patients assigned to the DSI protocol but for whom the decision to intubate was rescinded due to clinical improvement during the preoxygenation phase.
  • Use of a sedative agent other than ketamine for the RSI protocol.
  • Intubations performed by practitioners who have not received study-specific training on DSI and RSI protocols.
  • Duplicate enrollment due to recurrent presentations during the study period.

Trial locations and contacts

4 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Utku Murat Kalafat, Associate Professor contact

+90-507-262-74-04

utkumuratk@yahoo.com

Muhammed Güner, Doctor contact

+90-534-765-46-93

muhammedgner@gmail.com

Turkey (Türkiye)4 sites, 4 recruiting
  • Basaksehir Cam and Sakura City Hospital

    Istanbul, Istanbul, 34170

    Nihat Mujdat Hokenek, Assoc. Prof. Dr., +90-555-320-14-19, nihathokenek@gmail.com

    Nihat Mujdat Hokenek, Associate Professor

    Recruiting
  • İstanbul Haseki Training and Research Hospital

    Istanbul

    Özgür Söğüt, Professor Doctor, +90-533-669-26-87, ozgur.sogut@sbu.edu.tr

    Özgür Söğüt, Professor

    Recruiting
  • Kanuni Sultan Süleyman Research and Training Hospital

    Istanbul

    Utku Murat Kalafat, Associate Professor, +90-507-262-74-04, utkumuratk@yahoo.com

    Muhammed Güner, Resident Doctor, +90-543-765-46-93, muhammedgner@gmail.com

    Recruiting
  • Şişli Hamidiye Etfal Training and Research Hospital

    Istanbul

    Ertuğrul Altınbilek, Associate Professor, +90-505-904-68-33, ertugrul.altinbilek@sbu.edu.tr

    Ertuğrul Altınbilek, Associate Professor

    Recruiting

Other trials in Turkey (Türkiye)

About this study

Official title: Comparison of Peri-intubation Oxygenation Values and Complications in Patients Intubated With the Delayed Sequential Intubation (DSI) Versus Rapid Sequence Intubation (RSI) Protocols

This study compares two different methods of helping patients breathe by placing a tube in their airway (intubation) in an emergency setting. These methods are called Rapid Sequence Intubation (RSI) and Delayed Sequence Intubation (DSI).

The study focuses on adult patients who are still breathing on their own but need a breathing tube for medical reasons not related to an injury (non-trauma).

Read more

The main goal of the research is to compare:

  • Oxygen levels before and after the procedure.
  • The patient's vital signs (such as heart rate and blood pressure).
  • The number of attempts needed to successfully place the tube and the time the procedure takes.
  • Blood gas results and any complications that occur during or shortly after the procedure.
  • Early survival (mortality) rates.

While there are previous studies on trauma patients or small observational reports, there is currently no large-scale, multicenter randomized controlled trial that includes all non-trauma adult patients.

What makes this study unique? Confirmation of Tube Placement: Researchers will use a specific measurement called end-tidal CO2 (etCO2) to confirm the tube is in the right place, a method not used in similar previous studies.

Assessing Difficulty: This study will use the Cormack-Lehane classification system to measure how difficult the intubation was for each patient.

Standardization: For the first time, breathing machine (ventilator) settings will be standardized for all patients in this type of study.

Real-World Practice: By involving all emergency department physicians as practitioners, the study aims to show how these methods work across a wide range of medical teams.

Being tested
Delayed Sequence Intubation, Rapid Sequence Intubation
Keywords
delayed sequence intubation, rapid sequence intubation, RSI, DSI

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Delayed Sequence IntubationProcedure or surgery

    Patients assigned to the Delayed Sequence Intubation (DSI) protocol will receive an initial dose of 1 mg/kg ketamine. Titrated additional doses of 0.5 mg/kg will be administered until 'adequate sedation/dissociation' is achieved, ensuring the preservation of airway reflexes and spontaneous respiration. Subsequently, 'preoxygenation' will be performed for 3 minutes with 'appropriate positioning,' using a non-rebreather mask or bag-valve-mask combined with a nasal cannula delivering maximum oxygen flow (10-15 L/min). Following the induction of paralysis with an intravenous push of rocuronium (1 mg/kg), endotracheal intubation will be performed using direct laryngoscopy. Throughout the protocol, relevant physiological parameters will be recorded on the study data form by a designated physician.

  • Rapid Sequence IntubationProcedure or surgery

    Patients assigned to the Rapid Sequence Intubation (RSI) protocol will receive 'preoxygenation' for 3 minutes using a non-rebreather mask (NRM) or bag-valve-mask (BVM) combined with a nasal cannula delivering maximum oxygen flow (10-15 L/min), following the necessary preparation period. Subsequently, appropriate sedation and paralysis will be achieved through the sequential administration of intravenous (IV) ketamine (1 mg/kg push) and rocuronium (1 mg/kg IV push). Following induction, endotracheal intubation will be performed via direct laryngoscopy. Throughout the protocol, relevant physiological parameters will be recorded on the study data form by a designated physician

Study groups in NCT07380763
Study groupRoleWhat they receive
Delayed Sequence IntubationExperimentalNot described
Receives: Procedure: Delayed Sequence Intubation
Rapid Sequence IntubationActive comparatorNot described
Receives: Procedure: Rapid Sequence Intubation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants with Procedure-Related Adverse Events

    Hypoxia(Spo2<90), hypotension (systolic blood pressure <90mmHg or blood pressure drop >20mmg after intiation of intubation protocol), orogastric intubation, cardiac arrest, orolaryngeal trauma, aspiration of orogastric fluid is accepted as procedure-related adverse events

    Measured: During and 1 hours after intubation

  2. Mean Peripheral Oxygen Saturation (SpO2)

    Spo2 levels at admission, when intubation decision made, Spo2 level upon commencement of the intubation protocol(0-min); Spo2 level at 1st minute, 2nd minute, 3rd minute of intubation protocol, during blade passes incisor teeth, 1 minutes after intubation, 5 minutes after intubation wil be recorded

    Measured: Hospital admission, Intubation decision, Protocol start (0 min), Minutes 1, 2, 3 of protocol, During blade insertion, 1 minute post-intubation, and 5 minutes post-intubation

  3. Mean Arterial Blood pH Levels

    Evaluation of acid-base status.

    Measured: Hospital admission, At the time of intubation decision, and 15 minutes post-intubation.

  4. Mean Partial Pressure of Carbon Dioxide (PaCO2)

    Measure of carbon dioxide in arterial blood.

    Measured: Hospital admission, At the time of intubation decision, and 15 minutes post-intubation.

  5. Mean Arterial Bicarbonate (HCO3) Concentration

    Measure of bicarbonate in arterial blood.

    Measured: Hospital admission, At the time of intubation decision, and 15 minutes post-intubation.

  6. Mean Base Excess (BE) Levels

    Measure of base excess in arterial blood.

    Measured: Hospital admission, At the time of intubation decision, and 15 minutes post-intubation.

  7. Mean Arterial Lactate Concentration

    Measure of lactate in arterial blood.

    Measured: Hospital admission, At the time of intubation decision, and 15 minutes post-intubation.

  8. First Hour Mortality

    Death from any cause within 60 minutes following the intubation attempt.

    Measured: 1 hour later intubation

  9. 28th day mortality

    All-cause mortality recorded during the first 28 days after enrollment.

    Measured: 28 days after intubation

Secondary outcomes (2)
  1. Number of intubation attempts

    From the initiation of intubation until successful intubation is achieved.

    Measured: During the procedure (from the start of the intubation attempt until confirmation of tube placement).

  2. Intubation Duration

    Time from the laryngoscope blade passing the incisors until successful ETT placement.

    Measured: During the procedure (from the start of the intubation attempt until confirmation of tube placement).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Feb 2026
  2. Study start29 Oct 2025
  3. Primary completion29 May 2026 (estimated)
  4. Study completion29 Jun 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
140 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07380763
Sponsor's protocol ID
4975
Other IDs
2024-KAEK-18
Acronym
DSI vs RSI
Status last verified
Jan 2026
First submitted
15 Jan 2026
Last updated
2 Feb 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: After publication and upon reasonable request

Publications

  • Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The Physiologically Difficult Airway. West J Emerg Med. 2015 Dec;16(7):1109-17. doi: 10.5811/westjem.2015.8.27467. Epub 2015 Dec 8.

    PubMed 26759664
  • Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed sequence intubation: a prospective observational study. Ann Emerg Med. 2015 Apr;65(4):349-55. doi: 10.1016/j.annemergmed.2014.09.025. Epub 2014 Oct 23.

    PubMed 25447559
  • Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. doi: 10.1016/j.annemergmed.2011.10.002. Epub 2011 Nov 3.

    PubMed 22050948
  • Stanke L, Nakajima S, Zimmerman LH, Collopy K, Fales C, Powers W 4th. Hemodynamic Effects of Ketamine Versus Etomidate for Prehospital Rapid Sequence Intubation. Air Med J. 2021 Sep-Oct;40(5):312-316. doi: 10.1016/j.amj.2021.05.009. Epub 2021 Jul 2.

    PubMed 34535237
  • Sehdev RS, Symmons DA, Kindl K. Ketamine for rapid sequence induction in patients with head injury in the emergency department. Emerg Med Australas. 2006 Feb;18(1):37-44. doi: 10.1111/j.1742-6723.2006.00802.x.

    PubMed 16454773

Questions about this trial

What is this clinical trial studying?

A study testing Delayed Sequence Intubation and Rapid Sequence Intubation in people with Delayed Sequence Intubation and Rapid Sequence Induction and Intubation, run by Kanuni Sultan Suleyman Training and Research Hospital at 4 sites in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 2 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Utku Murat Kalafat, Associate Professor (+90-507-262-74-04, utkumuratk@yahoo.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants with Procedure-Related Adverse Events (time frame: During and 1 hours after intubation). The study lists 9 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07380763, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Feb 2026.

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