Comparison of time to sedation after rapid sequence intubation using long-acting neuromuscular blockers between the ED and ICU.

OBJECTIVE

To compare the proportion of patients who receive an appropriate sedative within 15 min of receiving rocuronium for intubation between Emergency Department (ED) and Intensive Care Unit (ICU) patients. The study aims to assess whether patients receive appropriate sedation within 15 min of paralysis as delays in sedation can result in paralysis with awareness which can result in psychological harm. Comparing results between these two critical care areas can identify process improvement targets for future efforts.

METHODS

Retrospective chart review of patients intubated using rocuronium in the ED or ICU at a large urban academic medical center. We included those 18-89 years of age, and use of rocuronium for Rapid Sequence Intubation (RSI). The primary outcome is the proportion of patients given a sedative agent given within 15 min of induction (N%). Secondary outcomes include comparison between those intubated in the ED and ICU on time to sedation after intubation, total amount of sedative/analgesic given within first 60 min vs 60-120 min post-RSI, and patient sedation intensity scores between 0 and 60 vs 61-120 min post-RSI.

RESULTS

370 patients were included in the final analysis. A similar proportion of patients received sedatives within 15 min of induction agent administration in the ED and ICU (39 % vs. 40 %; difference 0.8 %, 95 % CI -10.6 to 9.1). The median time to sedation following RSI was 15 min in the ED and 13 min in the ICU (difference 2.0 %, 95 % CI -5.5 to 5.0). The relative amount of sedation received after RSI significantly increased in both groups from the first and second hours, likely correlating to the return of neuromuscular function in the second hour and ability to assess sedative requirements.

CONCLUSION

Patients in the ED and ICU face low rates of timely sedation following RSI with rocuronium.