Cappuccilli Amanda C, Sarangarm Preeyaporn, Dukes Joanna, Kaucher Kevin
Department of Pharmacy, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
Am J Emerg Med. 2025 Jun 17;96:128-133. doi: 10.1016/j.ajem.2025.06.042.
To compare the proportion of patients who receive an appropriate sedative within 15 min of receiving rocuronium for intubation between Emergency Department (ED) and Intensive Care Unit (ICU) patients. The study aims to assess whether patients receive appropriate sedation within 15 min of paralysis as delays in sedation can result in paralysis with awareness which can result in psychological harm. Comparing results between these two critical care areas can identify process improvement targets for future efforts.
Retrospective chart review of patients intubated using rocuronium in the ED or ICU at a large urban academic medical center. We included those 18-89 years of age, and use of rocuronium for Rapid Sequence Intubation (RSI). The primary outcome is the proportion of patients given a sedative agent given within 15 min of induction (N%). Secondary outcomes include comparison between those intubated in the ED and ICU on time to sedation after intubation, total amount of sedative/analgesic given within first 60 min vs 60-120 min post-RSI, and patient sedation intensity scores between 0 and 60 vs 61-120 min post-RSI.
370 patients were included in the final analysis. A similar proportion of patients received sedatives within 15 min of induction agent administration in the ED and ICU (39 % vs. 40 %; difference 0.8 %, 95 % CI -10.6 to 9.1). The median time to sedation following RSI was 15 min in the ED and 13 min in the ICU (difference 2.0 %, 95 % CI -5.5 to 5.0). The relative amount of sedation received after RSI significantly increased in both groups from the first and second hours, likely correlating to the return of neuromuscular function in the second hour and ability to assess sedative requirements.
Patients in the ED and ICU face low rates of timely sedation following RSI with rocuronium.
比较急诊科（ED）和重症监护病房（ICU）患者在接受罗库溴铵进行插管后15分钟内接受适当镇静剂的患者比例。该研究旨在评估患者在麻痹后15分钟内是否接受了适当的镇静，因为镇静延迟可能导致清醒状态下的麻痹，进而造成心理伤害。比较这两个重症监护领域的结果可以确定未来努力的流程改进目标。
对一家大型城市学术医疗中心急诊科或重症监护病房使用罗库溴铵进行插管的患者进行回顾性病历审查。我们纳入了年龄在18 - 89岁之间且使用罗库溴铵进行快速顺序诱导插管（RSI）的患者。主要结局是诱导后15分钟内给予镇静剂的患者比例（N%）。次要结局包括比较急诊科和重症监护病房插管患者插管后至镇静的时间、快速顺序诱导插管后前60分钟与60 - 120分钟内给予的镇静剂/镇痛药总量，以及快速顺序诱导插管后0至60分钟与61 - 120分钟之间的患者镇静强度评分。
370例患者纳入最终分析。急诊科和重症监护病房在诱导剂给药后15分钟内接受镇静剂的患者比例相似（39%对40%；差异0.8%，95%可信区间-10.6至9.1）。快速顺序诱导插管后至镇静的中位时间在急诊科为15分钟，在重症监护病房为13分钟（差异2.0%，95%可信区间-5.5至5.0）。两组在快速顺序诱导插管后接受的镇静相对量从第一小时到第二小时均显著增加，这可能与第二小时神经肌肉功能恢复以及评估镇静需求的能力有关。
急诊科和重症监护病房的患者在使用罗库溴铵进行快速顺序诱导插管后及时镇静的比例较低。
