Interventions to improve emergency department postintubation sedation and analgesia: a systematic review

Mechanically ventilated emergency department (ED) patients require appropriate postintubation sedation and analgesia. Many investigators have published reports of their interventions to improve ED postintubation sedation and analgesia, but this work has not been systematically or critically evaluated.

We performed a systematic review of studies reporting original clinical research on interventions to improve ED postintubation sedation and analgesia. We identified studies for inclusion via a secondary analysis of a recent scoping review on ED postintubation sedation and analgesia. Two investigators independently abstracted data and graded study quality; a third investigator adjudicated any disagreements.

We identified 22 studies meeting our inclusion criteria, of which 11 were conference abstracts. Meta-analysis was not pursued due to substantial heterogeneity, primarily in outcome definitions. Methods described included educational interventions (n = 18) and protocols, guidelines, order sets, and checklists (n = 16). Ten studies reported improvement in a prespecified primary outcome directly related to ED postintubation sedation. Outcome definitions were heterogeneous. Most interventions were not described in adequate detail to permit replication, and implementation science techniques and frameworks were identified in only 3 studies.

There is a small- to moderate-sized body of evidence to guide interventions to improve ED postintubation sedation and analgesia that is limited by heterogeneous outcome definitions and poor reporting of methods. Future work should include consistent, patient-centered outcome selection and rigorous reporting in adherence to guidelines on education and implementation research.