• Brian M Fuller, Brian W Roberts, Nicholas M Mohr, William A Knight, Opeolu Adeoye, Ryan D Pappal, Stacy Marshall, Robert Alunday, Matthew Dettmer, Munish Goyal, Colin Gibson, Brian J Levine, Jayna M Gardner-Gray, Jarrod Mosier, James Dargin, Fraser Mackay, Nicholas J Johnson, Sharukh Lokhandwala, Catherine L Hough, Joseph E Tonna, Rachel Tsolinas, Frederick Lin, Zaffer A Qasim, Carrie E Harvey, Benjamin Bassin, Robert J Stephens, Yan Yan, Christopher R Carpenter, Marin H Kollef, and Michael S Avidan.
• Division of Critical Care, Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO.
• Crit. Care Med. 2019 Nov 1; 47 (11): 1539-1548.

ObjectivesTo characterize emergency department sedation practices in mechanically ventilated patients, and test the hypothesis that deep sedation in the emergency department is associated with worse outcomes.DesignMulticenter, prospective cohort study.SettingThe emergency department and ICUs of 15 medical centers.PatientsMechanically ventilated adult emergency department patients.InterventionsNone.Measurements And Main ResultsAll data involving sedation (medications, monitoring) were recorded. Deep sedation was defined as Richmond Agitation-Sedation Scale of -3 to -5 or Sedation-Agitation Scale of 2 or 1. A total of 324 patients were studied. Emergency department deep sedation was observed in 171 patients (52.8%), and was associated with a higher frequency of deep sedation in the ICU on day 1 (53.8% vs 20.3%; p < 0.001) and day 2 (33.3% vs 16.9%; p = 0.001), when compared to light sedation. Mean (SD) ventilator-free days were 18.1 (10.8) in the emergency department deep sedation group compared to 20.0 (9.8) in the light sedation group (mean difference, 1.9; 95% CI, -0.40 to 4.13). Similar results according to emergency department sedation depth existed for ICU-free days (mean difference, 1.6; 95% CI, -0.54 to 3.83) and hospital-free days (mean difference, 2.3; 95% CI, 0.26-4.32). Mortality was 21.1% in the deep sedation group and 17.0% in the light sedation group (between-group difference, 4.1%; odds ratio, 1.30; 0.74-2.28). The occurrence rate of acute brain dysfunction (delirium and coma) was 68.4% in the deep sedation group and 55.6% in the light sedation group (between-group difference, 12.8%; odds ratio, 1.73; 1.10-2.73).ConclusionsEarly deep sedation in the emergency department is common, carries over into the ICU, and may be associated with worse outcomes. Sedation practice in the emergency department and its association with clinical outcomes is in need of further investigation.

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