Inadequate Administration of Post-Intubation Sedation and Analgesia in the Pediatric Emergency Department (PED)

Date

2023

Authors

Oad, Shayrin
Wolf, Haley
Hamby, Tyler
Sainna, Ruth
Selby, Sam

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Abstract

Purpose:

Previous adult studies demonstrate patients in emergency departments (ED) often do not receive subsequent sedative or analgesic medications within the intubation medication’s duration of action (DOA). These patients can experience pain or remember events while still being under the effects of the paralytic medication. Inadequate sedation following intubation increases rates of adverse events. The purpose of this project was to evaluate if pediatric patients intubated in the Cook Children’s Medical Center ED (CCMC ED) are administered timely post-intubation sedation and analgesia.

Methods:

Chart review was performed for patients intubated in the CCMC ED between June and December 2021. Exclusion criteria included intubation at another facility and charts with incomplete data. Data were collected for medications administered, time of medication administration, and intubation time.

Results:

There were 106 patients intubated in the CCMC ED meeting inclusion criteria. Following intubation, 17 (16%) patients were provided with a sedative or analgesic within the DOA of the sedative or analgesic used for induction, while the remaining 89 (84%) were inadequately medicated. Thirty-one patients (29%) did receive a sedative or analgesic following intubation but not within the DOA of the initial agent. The remaining 58 (55%) patients were inadequately medicated due to a lack of medication administration before intubation, following intubation, or both.

Conclusions:

The majority of intubations in the CCMC ED were not adequately medicated with sedatives and/or analgesics after intubation. Thus, these patients were at risk of suboptimal levels of sedation while paralyzed following intubation. Given the adverse effects of inadequate sedation seen in previous studies, timely administration of further sedation and analgesia after intubation may lead to decreased adverse events. Quality improvement interventions are being implemented in the CCMC ED to improve post-intubation sedation and analgesia administration.

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