Post-intubation sedation in the emergency department: A scoping review

Emergency departments (EDs) frequently manage patients who require intubation and mechanical ventilation. Post-intubation sedation is a critical component of ventilator management but is understudied in the ED environment. We conducted a scoping review to collate, characterize, and assess the existing biomedical literature on post-intubation sedation in the ED.

We searched multiple biomedical databases from inception through July 2025. We included completed original clinical research involving human patients undergoing mechanical ventilation in an ED setting, which reported clinically meaningful data regarding post-intubation sedation. We excluded non-clinical and non-original research. Conference abstracts and studies reporting on mixed ED and non-ED populations were included. Two authors reviewed studies for inclusion, and one author abstracted data.

We identified 80 studies meeting inclusion criteria, with 45 (56 %) available as manuscripts and 35 (44 %) as conference abstracts. Forty-five (56 %) were retrospective cohort studies, and 62 (78 %) were single center. There was substantial heterogeneity in definitions of post-intubation sedation and analgesia, inclusion and exclusion criteria, and reporting of post-intubation sedation medications. Patient-centered outcomes and process metrics, particularly safety outcomes and awareness under paralysis, were poorly reported. Associations between specific medications for post-intubation sedation and clinical outcomes were rarely investigated.

We identified many studies on ED post-intubation sedation, but they were limited by their primarily retrospective and single center methodology, and by substantial heterogeneity in definitions and outcome reporting. Further high-quality research with more rigorous methods and comprehensive outcome reporting is needed.