Sedation practices in patients intubated in the emergency department compared with those in patients in the intensive care unit.

In a single-center retrospective study of 264 mechanically ventilated adults, those intubated in the emergency department took longer to reach light sedation (median 13.5 hours) than those intubated in the intensive care unit (median 10.5 hours). Within 24 hours, 68% of emergency department patients achieved light sedation compared with 82% of intensive care unit patients. Ketamine was used more often for intubation in the emergency department (61% vs 40%), while propofol, benzodiazepines, and fentanyl were used more frequently in the intensive care unit. Patients intubated in the emergency department were 36% less likely to achieve light sedation within 24 hours (adjusted hazard ratio 0.64).

Study at a glance

Abstract

This study aimed to compare sedation management during and after intubation in the emergency department with that in the intensive care unit. This was a single-center retrospective cohort study of adults who were intubated in the emergency department or intensive care unit and who received mechanical ventilation between January 2018 and February 2022. We collected data from electronic medical records. The primary outcome was the duration from intubation to the first documentation of light sedation, which was defined as a Sedation Agitation Scale score of 3 - 4. This study included 264 patients, 95 (36%) of whom were intubated in the emergency department and 169 (64%) in the intensive care unit. With respect to the anesthetic agents used for intubation, ketamine was the most frequently used drug in the emergency department and was used more frequently than in the intensive care unit (61% versus 40%; p = 0.001). Propofol was the predominant sedative used in the intensive care unit, with a higher prevalence than in the emergency department (50% versus 33%; p = 0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the intensive care unit (39% versus 6%; p < 0.001 and 68% versus 9.5%; p < 0.001, respectively). Within 24 hours after intubation, 68% (65/95) of the emergency department patients and 82% (138/169) of the patients intubated in the intensive care unit achieved light sedation, with median durations of 13.5 hours and 10.5 hours, respectively. Patients who were intubated in the emergency department were less likely to achieve light sedation at 24 hours (adjusted hazard ratio 0.64; p = 0.04; 95%CI, 0.42 - 0.97). Compared with intensive care unit patients, critically ill patients who were intubated in the emergency department are at risk of deeper sedation and a longer time to achieve light sedation.