Current practices and safety of medication use during rapid sequence intubation

• Published in: Journal of critical care 2018-06, Vol.45, p.65-70
• Main Authors: Groth, Christine M., Acquisto, Nicole M., Khadem, Tina
• Format: Article
• Language: English
• Subjects: Adult; Adverse effects; Aged; Aged, 80 and over; Anesthesia; Cardiac arrhythmia; Clinical practice guidelines; Critical care; Cross-Sectional Studies; Delirium; Demographics; Drug administration; Drug dosages; Drug therapy; Emergency department; Emergency medical care; Emergency Medicine; Emergency Treatment; Etomidate - administration & dosage; Female; Guideline Adherence; Hospitals; Humans; Hypertension; Hypnotics and Sedatives - administration & dosage; Intensive care; Intensive Care Unit (ICU); Intubation; Intubation, Intratracheal - methods; Ketamine; Ketamine - administration & dosage; Male; Medications; Middle Aged; Patient safety; Pediatrics; Practice Patterns, Physicians' - statistics & numerical data; Rapid sequence intubation (RSI); Succinylcholine - administration & dosage; Vital signs
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2018.01.017

Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events. This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation. A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%). During RSI, 21%, 87%, and 77% received pre-induction, induction, and paralysis, respectively. Significant differences in medication use by provider type were seen. Etomidate was administered to 58% with sepsis, but was not associated with adrenal insufficiency. Ketamine was associated with hypotension post-RSI [RR = 1.78 (1.36–2.35)] and use was low with traumatic brain injury/stroke (1.5%). Succinylcholine was given to 67% of patients with baseline bradycardia and was significantly associated with bradycardia post-RSI [RR = 1.81 (1.11–2.94)]. An additional 13% given succinylcholine had contraindications. Sedation practices post-RSI were not consistent with current practice guidelines and most receiving a non-depolarizing paralytic did not receive adequate sedation post-RSI. Medication practices during RSI vary amongst provider and medications are often used inappropriately. There is opportunity for optimization of medication use during RSI. •Rapid sequence intubation medication practices vary amongst providers throughout the United States•Medications are often used inappropriately based on patient hemodynamics and contraindications•Ketamine was associated with hypotension post-RSI•Succinylcholine was given to 67% with baseline bradycardia and was significantly associated with bradycardia post-RSI•Sedation practices post-RSI were not consistent with national guidelines in the majority of patients