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Am J Emerg Med. 2019 May 6. pii: S0735-6757(19)30304-3. doi: 10.1016/j.ajem.2019.05.010. [Epub ahead of print]

Factors associated with post-intubation sedation after emergency department intubation: A Report from The National Emergency Airway Registry.

Author information

1
Department of Emergency Medicine, Saint Vincent Hospital, Erie, PA, United States of America.
2
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
3
Department of Emergency Medicine, Saint Vincent Hospital, Erie, PA, United States of America. Electronic address: jestin.carlson@ahn.org.

Abstract

BACKGROUND:

Previous work has suggested low rates of post-intubation sedation in patients undergoing endotracheal intubation (ETI) in the emergency department (ED) with limited data examining factors associated with sedation use. Utilizing a national database; we sought to determine the frequency of post-intubation sedation and associated factors.

METHODS:

We performed a retrospective analysis of a prospectively collected database (National Emergency Airway Registry (NEAR) from 25 EDs from January 1, 2016 to December 31, 2017). Patients were considered to have received post-intubation sedation if they received any of the following medications within 15 min of ETI completion; propofol, midazolam, diazepam, ketamine, etomidate, fentanyl, and morphine. We calculated odds ratios for post-intubation sedation.

RESULTS:

Of the 11,748 eligible intubations, 9099 received post-intubation sedation (77.5%) while 2649 did not (22.5%). Pre-intubation hypotension (odds ratio; 95% confidence Interval) (0.27; 0.24-0.31) and post-intubation hypotension (0.27; 0.24-0.31) were associated with lower odds of post-intubation sedation. Patients with a medical indication compared to a traumatic indication for ETI had higher odds of receiving post-intubation sedation (1.16; 1.05-1.28) as did those that underwent rapid sequence intubation (15.15; 13.56-16.93). Use of succinylcholine was associated with a higher odd of post-intubation sedation compared to a long-acting neuromuscular blocking agent (i.e. rocuronium or vecuronium) (1.89; 1.68-2.12).

CONCLUSION:

Post-intubation sedation rates in NEAR are higher than previously reported and multiple factors including the indication for intubation and succinylcholine use, are associated with higher odds of receiving post-intubation sedation.

KEYWORDS:

Intubation; Sedation

PMID:
31130369
DOI:
10.1016/j.ajem.2019.05.010

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