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Published on: January 17, 2011
Postintubation Sedation of Pediatric Patients in the Emergency Department: A Systematic Review and Meta-Analysis
Emily Wynia1, Kevin Baumgartner2, Lauren H Yaeger3
1Division of Pediatric Emergency Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Insights
Postintubation sedation for pediatric emergency department patients is under-researched. Sedation is often delayed or not administered, highlighting a need for improved quality of care and further studies.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Pharmacology
Background:
- Postintubation sedation is vital for mechanically ventilated patients in ICUs and adult EDs.
- Limited data exist on postintubation sedation practices for pediatric ED patients.
Purpose of the Study:
- To systematically review and analyze existing literature on postintubation sedation in pediatric ED patients.
- To critique the quality and identify gaps in current research.
Main Methods:
- Comprehensive literature search across multiple databases (Embase, Medline, Scopus, Cochrane).
- Inclusion criteria: pediatric (<18 years) ED patients undergoing rapid sequence intubation (RSI) and receiving postintubation sedation.
- Data extraction focused on study design, demographics, sedation protocols, and outcomes.
Main Results:
- 10 nonrandomized studies were included, showing significant heterogeneity.
- Pooled estimates: 77.3% received any sedation, 43.5% received appropriately timed sedation.
- Median time to sedation was 18.6 minutes, with considerable delays noted.
Conclusions:
- Evidence on pediatric ED postintubation sedation is scarce and of low quality.
- Sedation administration is inconsistent and frequently delayed.
- High-quality research and quality improvement initiatives are essential for optimal patient care.
Context:
Postintubation sedation is a critical intervention for patients undergoing mechanical ventilation. Research in the intensive care unit (ICU) and adult emergency department (ED) demonstrates that appropriate postintubation sedation has a significant impact on patient outcomes. There are minimal published data regarding postintubation sedation for pediatric ED patients.
Objective:
To identify, describe, and critique published literature on postintubation sedation in pediatric ED patients.
Data Sources:
Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.Gov.
Study Selection:
Studies describing postintubation sedation in the ED for pediatric patients (<18 years of age) intubated in the ED via rapid sequence intubation (RSI) were included. Studies reporting intubation outside the ED, intubation not by RSI, or nonpediatric patients were excluded, as were studies not reporting novel human clinical research.
Data Extraction:
Data were abstracted by 2 authors using a standardized worksheet. Data included study design & setting, demographics, medications for RSI and postintubation sedation, administration of any or appropriately timed postintubation sedation, and predictive factors for postintubation sedation-related outcomes.
Results:
A total of 10 studies were included, all of which were nonrandomized; there was significant heterogeneity and many key variables and outcomes were not consistently reported. Meta-analysis of eligible studies demonstrated pooled estimates of 77.3% (95% confidence interval [CI]: 62.5-92.0) for proportion of patients receiving any postintubation sedation, 43.5% (95% CI: 29.3-57.6) for proportion of patients receiving appropriately timed postintubation sedation, and 18.6 minutes (95% CI: 12.5-24.7) for median time to postintubation sedation, all with significant heterogeneity.
Conclusions:
Data on postintubation sedation in pediatric ED patients are limited. Administration of postintubation sedation is inconsistent and may be substantially delayed. Further high-quality research into the use of postintubation sedation in this setting is needed, and appropriate postintubation sedation should be a target for quality improvement.
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