Estimates of sedation in patients undergoing endotracheal intubation in US EDs

Weingart, Gregory S.; Carlson, Jestin N.; Callaway, Clifton W.; Frank, Robert; Wang, Henry E.

doi:10.1016/j.ajem.2012.05.015

Cited by 33 publications

(25 citation statements)

References 12 publications

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“…Further, a significant percentage (up to 45%) of ED patients have been documented in previous literature to receive no analgesia or sedation after intubation 8. Approximately 90% of patients receive an NMB for intubation in the ED, with a recent trend of increased use of long-acting NMB for intubation (ie, rocuronium vs succinylcholine), and up to 25% receive a long-acting NMB after intubation 7–10. In the ED, these paralysed patients typically receive less analgesia and sedation, lower doses and in a delayed fashion 7.…”

Section: Introductionmentioning

confidence: 99%

“…OR-based studies demonstrate that some critical risk factors for awareness include: (1) a total intravenous anaesthetic approach (as opposed to inhaled); (2) underdosing of anaesthesia; (3) neuromuscular blocker (NMB) use and (4) a lack of protocolled monitoring of sedation depth 1. Critically ill ED patients requiring mechanical ventilation almost exclusively receive intravenous medications, and are frequently underdosed 6–8. Further, a significant percentage (up to 45%) of ED patients have been documented in previous literature to receive no analgesia or sedation after intubation 8.…”

Section: Introductionmentioning

confidence: 99%

“…Critically ill ED patients requiring mechanical ventilation almost exclusively receive intravenous medications, and are frequently underdosed 6–8. Further, a significant percentage (up to 45%) of ED patients have been documented in previous literature to receive no analgesia or sedation after intubation 8. Approximately 90% of patients receive an NMB for intubation in the ED, with a recent trend of increased use of long-acting NMB for intubation (ie, rocuronium vs succinylcholine), and up to 25% receive a long-acting NMB after intubation 7–10.…”

Section: Introductionmentioning

confidence: 99%

“…Human factors likely play a role in the historical lack of relevance given to awareness in critically ill mechanically ventilated patients, as cardiovascular instability or an obtunded mental state may lead clinicians to believe patients are incapable of awareness recall. This may lead to the underdosing of analgesics and sedatives 8. However, the fifth National Audit Project on accidental awareness in the UK and Ireland documented accidental awareness in critically ill and unstable patients, demonstrating that critical illness does not guarantee that memory of events will not occur 3.…”

Section: Introductionmentioning

confidence: 99%

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Protocol for a prospective, observational cohort study of awareness in mechanically ventilated patients admitted from the emergency department: the ED-AWARENESS study

et al. 2019

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IntroductionAwareness with paralysis is a complication with potentially devastating psychological consequences for mechanically ventilated patients. While rigorous investigation into awareness has occurred for operating room patients, little attention has been paid outside of this domain. Mechanically ventilated patients in the emergency department (ED) have been historically managed in a way that predisposes them to awareness events: high incidence of neuromuscular blockade use, underdosing of analgesia and sedation, delayed administration of analgesia and sedation after intubation, and a lack of monitoring of sedation targets and depth. These practice patterns are discordant to recommendations for reducing the incidence of awareness, suggesting there is significant rationale to examine awareness in the ED population.Methods and analysisThis is a single centre, prospective cohort study examining the incidence of awareness in mechanically ventilated ED patients. A cohort of 383 mechanically ventilated ED patients will be included. The primary outcome is awareness with paralysis. Qualitative reports of all awareness events will be provided. Recognising the potential problem with conventional multivariable analysis arising from a small number of events (expected less than 10—phenomenon of separation), Firth penalised method, exact logistic regression model or penalised maximum likelihood estimation shrinkage (Ridge, LASSO) will be used to assess for predictors of awareness.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Protocol for a prospective, observational cohort study of awareness in mechanically ventilated patients admitted from the emergency department: the ED-AWARENESS study

et al. 2019

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“…There also remains equipoise over what elements are essential for the most impactful airway checklists. Given the nearly 250,000 intubations that occur annually in U.S. emergency departments, a large multicenter trial is needed to focus and identify the effects of preintubation checklists on the care of the critical trauma patient …”

mentioning

confidence: 99%