Sereeyotin Jariya, Yarnell Christopher, Mehta Sangeeta
Department of Anesthesiology, Division of Critical Care Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University - Bangkok, Thailand.
Department of Medicine, Sinai Health, Interdepartmental Division of Critical Care Medicine, University of Toronto - Toronto, Ontario, Canada.
Crit Care Sci. 2025 May 26;37:e20250247. doi: 10.62675/2965-2774.20250247. eCollection 2025.
This study aimed to compare sedation management during and after intubation in the emergency department with that in the intensive care unit.
This was a single-center retrospective cohort study of adults who were intubated in the emergency department or intensive care unit and who received mechanical ventilation between January 2018 and February 2022. We collected data from electronic medical records. The primary outcome was the duration from intubation to the first documentation of light sedation, which was defined as a Sedation Agitation Scale score of 3 - 4.
This study included 264 patients, 95 (36%) of whom were intubated in the emergency department and 169 (64%) in the intensive care unit. With respect to the anesthetic agents used for intubation, ketamine was the most frequently used drug in the emergency department and was used more frequently than in the intensive care unit (61% versus 40%; p = 0.001). Propofol was the predominant sedative used in the intensive care unit, with a higher prevalence than in the emergency department (50% versus 33%; p = 0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the intensive care unit (39% versus 6%; p < 0.001 and 68% versus 9.5%; p < 0.001, respectively). Within 24 hours after intubation, 68% (65/95) of the emergency department patients and 82% (138/169) of the patients intubated in the intensive care unit achieved light sedation, with median durations of 13.5 hours and 10.5 hours, respectively. Patients who were intubated in the emergency department were less likely to achieve light sedation at 24 hours (adjusted hazard ratio 0.64; p = 0.04; 95%CI, 0.42 - 0.97).
Compared with intensive care unit patients, critically ill patients who were intubated in the emergency department are at risk of deeper sedation and a longer time to achieve light sedation.
本研究旨在比较急诊科和重症监护病房在气管插管期间及之后的镇静管理情况。
这是一项单中心回顾性队列研究，研究对象为2018年1月至2022年2月期间在急诊科或重症监护病房接受气管插管并接受机械通气的成年患者。我们从电子病历中收集数据。主要结局是从气管插管到首次记录轻度镇静的持续时间，轻度镇静定义为镇静躁动评分3 - 4分。
本研究纳入264例患者，其中95例（36%）在急诊科插管，169例（64%）在重症监护病房插管。关于气管插管所用的麻醉剂，氯胺酮是急诊科最常用的药物，其使用频率高于重症监护病房（61%对40%；p = 0.001）。丙泊酚是重症监护病房使用的主要镇静剂，其使用率高于急诊科（50%对33%；p = 0.01）。此外，苯二氮䓬类药物和芬太尼在重症监护病房的使用频率更高（分别为39%对6%；p < 0.001和68%对9.5%；p < 0.001）。气管插管后24小时内，急诊科68%（65/95）的患者和重症监护病房82%（138/169）的插管患者实现了轻度镇静，中位持续时间分别为13.5小时和10.5小时。在急诊科插管的患者在24小时时实现轻度镇静的可能性较小（调整后风险比0.64；p = 有0.04；95%CI，0.42 - 0.97）。
与重症监护病房的患者相比，在急诊科插管 的危重症患者有深度镇静风险且达到轻度镇静的时间更长。
