Sedation practices in patients intubated in the emergency department compared to the intensive care unit.

Purpose This study aimed to compare sedation management during and after intubation in the emergency department (ED) versus the intensive care unit (ICU). Methods This was a single-center retrospective cohort study of adults intubated in the ED or in the ICU and received mechanical ventilation between January 2018 and February 2022. We collected data from the electronic medical record. The primary outcome was duration from intubation to first documentation of light sedation, defined as a Sedation Agitation Scale score (SAS) of 3-4. Results The study included 264 patients, with 95 (36%) intubated in the ED and 169 (64%) in the ICU. Regarding anesthetic agents used for intubation, ketamine was the most commonly used drug in the ED and was used more frequently than in the ICU (61% vs 40%, p=0.001). Propofol was the predominant sedative used in the ICU, with a higher prevalence compared to the ED (50% vs 33%, p=0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the ICU (39% vs 6%, p<0.001 and 68% vs 9.5%, p<0.001, respectively). Within 24 hours after intubation, 68% (65/95) ED patients and 82% (138/169) patients intubated in ICU achieved light sedation, with median durations of 13.5 hours and 10.5 hours. Patient location in the ED at intubation was associated with decreased probability of achieving light sedation at 24 hours (adjusted odds ratio 0.64, p=0.04). Conclusion Critically ill patients intubated in the ED are at risk of deeper sedation and a longer time to achieve light sedation compared to patients intubated in the ICU. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Sinai Health Research Ethics Board (REB#23-0002-C) on February 15th, 2023. Due to the retrospective research design and the fact that no identifying information would be collected, the need for informed consent was waived. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All relevant data are within the manuscript and its Supporting Information files.