Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED

Bhat, Rahul; Mazer‐Amirshahi, Maryann; Sun, Christie; Vaughns, Janelle D.; Dynin, Maria; Tefera, Eshetu; Towle, Daryn; Goyal, Munish

doi:10.1016/j.ajem.2016.09.056

Cited by 11 publications

(4 citation statements)

References 12 publications

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“…Prior ED-based sedation research demonstrated clinical practice patterns placing patients at high risk for AWP (12,13,(15)(16)(17)(18)(19)(20)61). Given this, the severe psychologic trauma that can result from AWP, and the paucity of ED-based data, we previously conducted the ED-AWARENESS Study to rigorously assess this complication in mechanically ventilated ED patients (22,23).…”

Section: Discussionmentioning

confidence: 99%

Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*

Fuller

Pappal

Mohr

et al. 2022

Critical Care Medicine

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OBJECTIVES: In mechanically ventilated patients, awareness with paralysis (AWP) can have devastating consequences, including post-traumatic stress disorder (PTSD), depression, and thoughts of suicide. Single-center data from the emergency department (ED) demonstrate an event rate for AWP factors higher than that reported from the operating room. However, there remains a lack of data on AWP among critically ill, mechanically ventilated patients. The objective was to assess the proportion of ED patients experiencing AWP and investigate modifiable variables associated with its occurrence. DESIGN: An a priori planned secondary analysis of a multicenter, prospective, before-and-after clinical trial. SETTING: The ED of three academic medical centers. PATIENTS: Mechanically ventilated adult patients that received neuromuscular blockers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All data related to sedation and analgesia were collected. AWP was the primary outcome, assessed with the modified Brice questionnaire, and was independently adjudicated by three expert reviewers. Perceived threat, in the causal pathway for PTSD, was the secondary outcome. A total of 388 patients were studied. The proportion of patients experiencing AWP was 3.4% (n = 13), the majority of whom received rocuronium (n = 12/13; 92.3%). Among patients who received rocuronium, 5.5% (n = 12/230) experienced AWP, compared with 0.6% (n = 1/158) among patients who did not receive rocuronium in the ED (odds ratio, 8.64; 95% CI, 1.11–67.15). Patients experiencing AWP had a higher mean (sd) threat perception scale score, compared with patients without AWP (15.6 [5.8] vs 7.7 [6.0]; p < 0.01). CONCLUSIONS: AWP was present in a concerning proportion of mechanically ventilated ED patients, was associated with rocuronium exposure in the ED, and led to increased levels of perceived threat, placing patients at greater risk for PTSD. Studies that aim to further quantify AWP in this vulnerable population and eliminate its occurrence are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*

Fuller

Pappal

Mohr

et al. 2022

Critical Care Medicine

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“…A previous retrospective study (n=440) has shown that medications used for RSI are more likely to be underdosed in the obese 16. The only NMBA evaluated in this study was succinylcholine and an appropriate dose was defined as 1–1.5 mg/kg of TBW.…”

Section: Discussionmentioning

confidence: 99%

Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department

Patanwala

Sakles

2017

Emerg Med J

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“…Improper dosing of RSI medications can cause significant patient discomfort and may increase the incidence of complications during intubation. Several recent studies demonstrated that obese patients often receive inappropriate doses of sedative and paralytic medications during RSI 30–32. Bhat and colleagues demonstrated that obese patients were more likely to be underdosed with both etomidate and succinylcholine during RSI 32.…”

Section: Intubationmentioning

confidence: 99%

“…Several recent studies demonstrated that obese patients often receive inappropriate doses of sedative and paralytic medications during RSI 30–32. Bhat and colleagues demonstrated that obese patients were more likely to be underdosed with both etomidate and succinylcholine during RSI 32. It is therefore important for the EP to be knowledgeable about the proper dosing of medications commonly used during RSI (Table).…”

Section: Intubationmentioning

confidence: 99%

The Crashing Obese Patient

Parker¹,

Manning²,

Winters³

2019

WestJEM

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Emergency physicians (EP) frequently resuscitate and manage critically ill patients. Resuscitation of the crashing obese patient presents a unique challenge for even the most skilled physician. Changes in anatomy, metabolic demand, cardiopulmonary reserve, ventilation, circulation, and pharmacokinetics require special consideration. This article focuses on critical components in the resuscitation of the crashing obese patient in the emergency department, namely intubation, mechanical ventilation, circulatory resuscitation, and pharmacotherapy. To minimize morbidity and mortality, it is imperative that the EP be familiar with the pearls and pitfalls discussed within this article.

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Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED

Cited by 11 publications

References 12 publications

Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*

Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*

Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department

The Crashing Obese Patient

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