Gouin P, Damm C, Villette-Baron K, Veber B, Dureuil B
Département d'anesthésie-réanimation chirurgicale-Samu, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
Ann Fr Anesth Reanim. 2008 May;27(5):390-6. doi: 10.1016/j.annfar.2008.03.004. Epub 2008 Apr 25.
In 1999, the Société française d'anesthésie et de réanimation (Sfar) published guidelines regarding sedation in prehospital setting. The recommendated protocol for emergency intubation was the rapid sequence induction (RSI). The aim of this study was to assess the impact of these guidelines on clinical practices.
A restrospective observational study was conducted in three French mobile emergency and intensive care units. In 1998, 2000 and 2004, during periods of four months, charts from every interventions were analyzed. All the patients over 15 years of age needing to be intubated and not in cardiac arrest were included. The following data were collected: anaesthetic protocol used for intubation, drugs used for maintenance of sedation, circumstances requiring tracheal intubation and side effects related to tracheal intubation or sedation. An anonymous questionnary form was also sent to all physicians from the three units in order to assess sedation protocol used for emergency intubation, knowledge regarding the Sfar conference.
Five hundred and thirty-one patients were included, and orotracheal intubation was performed in 84% of cases. RSI was administrated in 23% of cases in 1998, 45% in 2000 and 68% in 2004. Protocol for maintenance sedation complied the guidelines in 45% of cases in 1998, 68% in 2000 and 75% in 2004. Among the 62 physicians who answered the questionnary, 90% indicated they used RSI sequence for orotracheal intubation and 92% achieved sedation maintenance using midazolam fentanyl.
The Sfar guidelines regarding sedation in prehospital setting seem to meet a good compliance in clinical practice.
