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

Am J Emerg Med. 2020 Mar;38(3):466-470. doi: 10.1016/j.ajem.2019.05.010. Epub 2019 May 6.


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.

MeSH terms

  • Adult
  • Aged
  • Anesthetics, Intravenous / therapeutic use
  • Case-Control Studies
  • Conscious Sedation / methods
  • Conscious Sedation / statistics & numerical data*
  • Emergency Medical Services / methods*
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods*
  • Male
  • Middle Aged
  • Neuromuscular Depolarizing Agents / therapeutic use
  • Registries
  • Retrospective Studies


  • Anesthetics, Intravenous
  • Hypnotics and Sedatives
  • Neuromuscular Depolarizing Agents