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Postintubation Sedation Practices Within Multiple Emergency Departments Across a Large Pediatric Health Care

Pamela D Reiter, Monica L Bianchini, Scott Dietrich

  • 1From the Children's Hospital Colorado, Aurora.

Pediatric Emergency Care
|March 21, 2023
PubMed

Insights

Postintubation sedation (PIS) is frequently delayed in pediatric patients, increasing risks of paralysis without adequate sedation. Timely PIS administration is crucial, especially with short-acting induction agents, to ensure patient comfort and safety during intubation.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Patient Safety

Background:

  • Rapid sequence intubation carries risks of inadequate sedation when neuromuscular blockade duration exceeds induction agent effects.
  • Children undergoing intubation may experience paralysis without sufficient sedation.

Purpose of the Study:

  • To evaluate the rate of appropriately timed postintubation sedation (PIS) in pediatric patients across multiple emergency and urgent care sites.
  • To identify factors associated with timely PIS administration.

Main Methods:

  • Retrospective cohort study of 283 pediatric patients intubated between January 2016 and December 2021.
  • Exclusion criteria included intubation for status epilepticus or cardiac arrest.
  • Stepwise logistic regression was used to identify factors associated with appropriately timed PIS.

Main Results:

  • 83% of patients received PIS, but only 37% received it appropriately timed.
  • 16% of patients received no PIS.
  • Median time to PIS was 21 minutes; etomidate induction was associated with delayed PIS due to its short duration.

Conclusions:

  • Delayed PIS is common in pediatric emergency settings.
  • Providers must recognize the short duration of certain induction agents to ensure timely PIS.
  • Improved PIS timing is essential for patient safety and comfort.
Abstract

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