The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial

Abstract

Deep sedation in the emergency department (ED) is common, increases deep sedation in the ICU, and is negatively associated with outcome. Limiting ED deep sedation may, therefore, be a high-yield intervention to improve outcome. However, the feasibility of conducting an adequately powered ED-based clinical sedation trial is unknown. Our objectives were to assess trial feasibility in terms of: 1) recruitment, 2) protocol implementation and practice change, and 3) safety. Patient-centered clinical outcomes were assessed to better plan for a future large-scale clinical trial. DESIGN: Pragmatic, multicenter (n = 3), prospective before-after pilot and feasibility trial.

Rocuronium increases the risk of awareness with paralysis in mechanically ventilated ED patients: the need for multidisciplinary educational efforts

“…The study included patients who received an NMBA for endotracheal intubation or postintubation care. The investigation was a secondary analysis of a larger, multicentre, prospective trial 4. The primary outcome, AWP, was assessed using a modified Brice Questionnaire that was administered during the hospital stay or through a phone call after discharge.…”

The Practice Change and Clinical Impact of Lung-Protective Ventilation Initiated in the Emergency Department: A Secondary Analysis of Individual Patient-Level Data From Prior Clinical Trials and Cohort Studies*

“…This was a single-center, secondary cohort analysis of individual patient-level data from prior clinical trials and cohort studies, each of which has been previously published (10,11,(14)(15)(16)(17)(18)(19)(20)(21), and conducted at a tertiary, academic medical center. The preintervention group was composed of patients managed before ED-based lung-protective ventilation was instituted (10,11,(14)(15)(16).…”

Is “Set It and Forget It” Bad Medicine for Sedation and Analgesia for Intubated Emergency Department Patients?*

“…In 2012, Shehabi et al (8) demonstrated that early deep sedation was an independent risk factor for delayed extubation, hospital death, and 180-day mortality and the authors’ previous work identifies ED sedation as an important factor in ICU clinical outcomes (9). The study by Fuller et al (7) serves as a natural next step in questioning whether ICU outcomes in patients with respiratory failure can potentially be impacted by care that is delivered before arrival to the ICU. In this issue by Critical Care Medicine , the study by Fuller et al (7) confirm that there is wide variability in ED sedation depth documentation and supports the notion care provided in the ED impacts the arc of care for the critically ill.…”

“…The study by Fuller et al (7) serves as a natural next step in questioning whether ICU outcomes in patients with respiratory failure can potentially be impacted by care that is delivered before arrival to the ICU. In this issue by Critical Care Medicine , the study by Fuller et al (7) confirm that there is wide variability in ED sedation depth documentation and supports the notion care provided in the ED impacts the arc of care for the critically ill.…”

“…Despite the growing number of emergency physicians with additional training in critical care, most institutions do not have dual trained providers that practice in both the ED and the ICU environments. The authors in the study by Fuller et al (7) bring their experience caring for ICU patients to the ED and provide here another example of the benefit of multispecialty collaboration. The mission of Critical Care Medicine is to cover “all aspects of acute and emergency care for the critically ill or injured patient,” and the study by Fuller et al (7) clearly supports that mission.…”