Journal article
The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial
Critical care medicine, Vol.Publish Ahead of Print(8), p.1224
04/11/2022
DOI: 10.1097/CCM.0000000000005558
PMCID: PMC9288529
PMID: 35404327
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.
Pragmatic, multicenter (n = 3), prospective before-after pilot and feasibility trial.
The ED and ICUs at three medical centers.
Consecutive, adult mechanically ventilation ED patients.
An educational initiative aimed at reliable ED sedation depth documentation and reducing the proportion of deeply sedated patients (primary outcome).
Sedation-related data in the ED and the first 48 ICU hours were recorded. Deep sedation was defined as a Richmond Agitation-Sedation Scale of -3 to -5 or a Sedation-Agitation Scale of 1-3. One thousand three hundred fifty-six patients were screened; 415 comprised the final population. Lighter ED sedation was achieved in the intervention group, and the proportion of deeply sedated patients was reduced from 60.2% to 38.8% (p < 0.01). There were no concerning trends in adverse events (i.e., inadvertent extubation, device removal, and awareness with paralysis). Mortality was 10.0% in the intervention group and 20.4% in the preintervention group (p < 0.01). Compared with preintervention, the intervention group experienced more ventilator-free days [22.0 (9.0) vs 19.9 (10.6)] and ICU-free days [20.8 (8.7) vs 18.1 (10.4)], p < 0.05 for both.
This pilot trial confirmed the feasibility of targeting the ED in order to improve sedation practices and reduce deep sedation. These findings justify an appropriately powered clinical trial regarding ED-based sedation to improve clinical outcomes.
Details
- Title: Subtitle
- The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial
- Creators
- Brian M Fuller - Washington University in St. LouisBrian W Roberts - Cooper University HospitalNicholas M Mohr - University of IowaBrett Faine - University of IowaAnne M Drewry - Washington University in St. LouisBrian T Wessman - Washington University in St. LouisEnyo Ablordeppey - Washington University in St. LouisRyan D Pappal - Washington University in St. LouisRobert J Stephens - Washington University in St. LouisThomas Sewatsky - Cooper University HospitalNicholas S Cho - Cooper University HospitalYan Yan - Washington University in St. LouisMarin H Kollef - Washington University in St. LouisChristopher R Carpenter - Washington University in St. LouisMichael S Avidan - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.Publish Ahead of Print(8), p.1224
- DOI
- 10.1097/CCM.0000000000005558
- PMID
- 35404327
- PMCID
- PMC9288529
- NLM abbreviation
- Crit Care Med
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Language
- English
- Date published
- 04/11/2022
- Academic Unit
- Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984296131202771
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