Estimates of sedation in patients undergoing endotracheal intubation in US EDs

Am J Emerg Med. 2013 Jan;31(1):222-6. doi: 10.1016/j.ajem.2012.05.015. Epub 2012 Jul 4.

Abstract

Background: Sedations after endotracheal intubation (ETI) reduce the risk of self-extubation, uncontrolled pain, and myocardial infarction. Although several small single-center studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED), little is known regarding post-ETI sedative drug practices nationally.

Methods: We performed a retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009. We identified all ED patient visits with ETI. Using the multiple probability sampling design of the National Hospital Ambulatory Medical Care Survey, we estimated the proportion of ETI patients receiving pharmacologic sedation, defined as benzodiazepines, opiates, or other sedative agents (propofol, ketamine, etc). We compared patients receiving sedative drugs with those who did not using descriptive statistics and univariable logistic regression.

Results: During the 4-year study period, 1071000 patients (95% confidence interval [CI], 839000-1303000) underwent ETI in the ED. Of intubated patients, 46.4% (95% CI, 40.2%-52.7%) received sedative drugs, most commonly benzodiazepines (67.9%). Of patients who survived to hospital admission, 57.4% (95% CI, 48.7%-65.7%) received sedative drugs. Patients were less likely to receive sedation if they were diagnosed with circulatory or cardiac disease (odds ratio, 0.51; P = .026). Use of sedative drugs was not associated with patient age, sex, race, geographic location, or extended ED length of stay (>2 hours).

Conclusion: Less than one-half of patients undergoing ETI in the ED receive sedative drugs while in the ED. These findings are congruent with prior smaller studies from single academic centers.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Infant
  • Infant, Newborn
  • Intubation, Intratracheal / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data
  • Retrospective Studies
  • United States

Substances

  • Hypnotics and Sedatives