Risk of Delayed Intubation After Presumed Opioid Overdose in the Emergency Department

The objective of this study was to evaluate the optimal duration of monitoring for patients with presumed opioid overdoses prior to a non-ICU admission, particularly in the context of the increasing prevalence of fentanyl analogs and other potent synthetic opioids. Given the critical role of emergency physicians in managing this public health crisis, the study aims to inform clinical decisionmaking regarding patient disposition after the initial overdose treatment.

The Fentalog Study, conducted through the American College of Medical Toxicology's Toxicology Investigators Consortium, is a prospective, multi-institutional project designed to identify patients presenting to the emergency department with acute opioid overdose, gather clinical details, and confirm substances through biologic testing. This study is a secondary analysis of the Fentalog Study that assessed the risk of "delayed intubation," defined as any intubation occurring after 4 hours of arrival to the emergency department.

Of the 1,591 patients included, only 9 (0.6%) required delayed intubation. Eight of these patients had nonrespiratory-related conditions contributing to the need for intubation. One patient only had respiratory-related conditions, had respiratory acidosis, and received a total of 6.4 mg naloxone before intubation.

This study provides evidence that delayed intubation after 4 hours of monitoring in patients with presumed opioid overdose is exceedingly rare.