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

Abstract

Purpose This study aimed to compare sedation management during and after intubation in the emergency department (ED) versus the intensive care unit (ICU). Methods This was a single-center retrospective cohort study of adults intubated in the ED or in the ICU and received mechanical ventilation between January 2018 and February 2022. We collected data from the electronic medical record. The primary outcome was duration from intubation to first documentation of light sedation, defined as a Sedation Agitation Scale score (SAS) of 3-4. Results The study included 264 patients, with 95 (36%) intubated in the ED and 169 (64%) in the ICU. Regarding anesthetic agents used for intubation, ketamine was the most commonly used drug in the ED and was used more frequently than in the ICU (61% vs 40%, p=0.001). Propofol was the predominant sedative used in the ICU, with a higher prevalence compared to the ED (50% vs 33%, p=0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the ICU (39% vs 6%, p<0.001 and 68% vs 9.5%, p<0.001, respectively). Within 24 hours after intubation, 68% (65/95) ED patients and 82% (138/169) patients intubated in ICU achieved light sedation, with median durations of 13.5 hours and 10.5 hours. Patient location in the ED at intubation was associated with decreased probability of achieving light sedation at 24 hours (adjusted odds ratio 0.64, p=0.04). Conclusion Critically ill patients intubated in the ED are at risk of deeper sedation and a longer time to achieve light sedation compared to patients intubated in the ICU.