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Series 03: Negatives of trams, trains, railways and model railways in N.S.W. and Australia, ca. 1920-1970 / chiefly photographed by Len A. Clark

AbstractBackgroundPrevious 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. MethodsWe 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. ResultsOf 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). ConclusionPost-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.

The American journal of emergency medicine, 2020-03, Vol.38 (3), p.466-470

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

Abstract Objective Neuromuscular paralysis without sedation is an avoidable medical error with negative psychologic and potentially physiologic consequences. We determine the frequency of long-acting paralysis without concurrent sedation among patients intubated in our emergency department (ED) or before arrival. Methods We performed a retrospective cohort study from July 2007 to August 2009. We chose this time interval because in 2006, our institution developed a multidisciplinary plan designed to improve care of intubated patients. We identified all mechanically ventilated patients using billing codes. We reviewed all records to identify use of long-acting neuromuscular blocking agents. We captured data on patient characteristics and location of intubation, using a standardized data collection form. We report bivariate risk ratios to quantify associations with lack of concurrent sedation. A priori, we defined concurrent sedation as administration of any sedative during the 60 minutes preceding and the 15 minutes after administration of the long-acting paralytic. Results Over the 26-month period of study, 292 patients received a long-acting paralytic. Of the 212 available for analysis, 39 (18%) did not receive concurrent sedation. Every decade of age increased the risk of paralysis without concurrent sedation by 1.2 (95% confidence interval [CI], 1.1-1.4). Paralysis for intubation (vs for transport or ventilation management) increased the odds of no sedation by 2.1 (95% CI, 1.2-3.7). No other covariates predicted nonsedation. Conclusion Absence of concurrent sedation was common among patients receiving long-acting neuromuscular paralysis before arrival or at our ED, despite implementation of a guideline to improve practice.

The American journal of emergency medicine, 2014-05, Vol.32 (5), p.452-456

Long-acting neuromuscular paralysis without concurrent sedation in emergency care

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Series 03: Negatives of trams, trains, railways and model railways in N.S.W. and Australia, ca. 1920-1970 / chiefly photographed by Len A. Clark

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

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Long-acting neuromuscular paralysis without concurrent sedation in emergency care

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