• Christine M Groth, Nicole M Acquisto, and Tina Khadem.
• University of Rochester Medical Center-coordinating site., 601 Elmwood Ave. Box 638, Rochester, NY 14642, United States. Electronic address: christine_groth@urmc.rochester.edu.
• J Crit Care. 2018 Jun 1; 45: 65-70.

PurposeCharacterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events.Materials And MethodsThis was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation.ResultsA total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%). During RSI, 21%, 87%, and 77% received pre-induction, induction, and paralysis, respectively. Significant differences in medication use by provider type were seen. Etomidate was administered to 58% with sepsis, but was not associated with adrenal insufficiency. Ketamine was associated with hypotension post-RSI [RR = 1.78 (1.36-2.35)] and use was low with traumatic brain injury/stroke (1.5%). Succinylcholine was given to 67% of patients with baseline bradycardia and was significantly associated with bradycardia post-RSI [RR = 1.81 (1.11-2.94)]. An additional 13% given succinylcholine had contraindications. Sedation practices post-RSI were not consistent with current practice guidelines and most receiving a non-depolarizing paralytic did not receive adequate sedation post-RSI.ConclusionsMedication practices during RSI vary amongst provider and medications are often used inappropriately. There is opportunity for optimization of medication use during RSI.Copyright © 2018 Elsevier Inc. All rights reserved.

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