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

• Published in: The American journal of emergency medicine 2020-03, Vol.38 (3), p.466-470
• Main Authors: Lembersky, Olga, Golz, Dustin, Kramer, Casey, Fantegrossi, Andrea, Carlson, Jestin N., Walls, Ron M., Brown, Calvin A.
• Format: Article
• Language: English
• Subjects: Age; Analgesics; Anesthesia; Datasets; Diazepam; Emergency medical care; Emergency medical services; Etomidate; Fentanyl; Head injuries; Hypotension; Intubation; Ketamine; Midazolam; Morphine; Patients; Propofol; Respiratory tract; Sedation; Ventilators
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.05.010

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. 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. 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). 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.