Rocuronium dosing for rapid sequence intubation: A retrospective analysis in ED and ICU settings

Rocuronium dosing varies in clinical practice, and optimal dosing has yet to be identified. Several studies have investigated differing dosing strategies and have suggested doses ≥1.2 mg/kg may lead to greater intubation success.

This study aimed to compare the impact of rocuronium dosing on first attempt intubation success during rapid sequence intubation (RSI) with video laryngoscopy in the emergency department (ED) and intensive care units (ICU).

This was a single-center, retrospective chart review of adult patients undergoing RSI with rocuronium doses ≤1.2 or > 1.2 mg/kg. The primary outcome was successful first attempt intubation. Secondary outcomes included number of intubation attempts, time to successful intubation, 30-day mortality rate, and hospital and ICU length of stay. Subgroup analyses were performed for patients with hypoperfusion states including sepsis and heart failure, and for patients with obesity.

Rocuronium doses >1.2 mg/kg were associated with significantly higher first attempt intubation success (100% vs. 89.5%; 95% confidence interval [CI] -0.2 to -0.03; p < 0.01) and fewer mean intubation attempts (1 vs. 1.1; 95% CI 0.01 to 0.20; p < 0.01). No statistically significant differences were observed in any other secondary outcomes or subgroup analyses.

Rocuronium doses >1.2 mg/kg significantly improved first attempt intubation success. However, no significant differences were observed in secondary clinical outcomes or in subgroup analyses across specific patient populations. Further research into the relationship between rocuronium dosing, first attempt intubation success, and clinical outcomes may inform more effective and evidence-based rocuronium dosing strategies.