• Clifton W Callaway, Henry E Wang, Jestin N Carlson, and Gregory S Weingart.
• Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
• Am J Emerg Med. 2013 Jan 1;31(1):222-6.

BackgroundSedations after endotracheal intubation (ETI) reduce the risk of self-extubation, uncontrolled pain, and myocardial infarction. Although several small single-center studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED), little is known regarding post-ETI sedative drug practices nationally.MethodsWe performed a retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009. We identified all ED patient visits with ETI. Using the multiple probability sampling design of the National Hospital Ambulatory Medical Care Survey, we estimated the proportion of ETI patients receiving pharmacologic sedation, defined as benzodiazepines, opiates, or other sedative agents (propofol, ketamine, etc). We compared patients receiving sedative drugs with those who did not using descriptive statistics and univariable logistic regression.ResultsDuring the 4-year study period, 1071000 patients (95% confidence interval [CI], 839000-1303000) underwent ETI in the ED. Of intubated patients, 46.4% (95% CI, 40.2%-52.7%) received sedative drugs, most commonly benzodiazepines (67.9%). Of patients who survived to hospital admission, 57.4% (95% CI, 48.7%-65.7%) received sedative drugs. Patients were less likely to receive sedation if they were diagnosed with circulatory or cardiac disease (odds ratio, 0.51; P = .026). Use of sedative drugs was not associated with patient age, sex, race, geographic location, or extended ED length of stay (>2 hours).ConclusionLess than one-half of patients undergoing ETI in the ED receive sedative drugs while in the ED. These findings are congruent with prior smaller studies from single academic centers.Copyright © 2013 Elsevier Inc. All rights reserved.

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