203 - A Characterization of Post-Intubation Ventilation, Analgesia, and Sedation in Children in a Pediatric Emergency Department

Poster Number: 203
Publication Number: 203.1786

Background: Rapid sequence intubation (RSI) and mechanical ventilation (MV) are lifesaving interventions provided in the Emergency Department (ED). Thousands of children undergo RSI in US EDs annually, yet few studies have investigated post-intubation ventilation, analgesia, and sedation.

Objective: This retrospective study evaluated clinical characteristics of patients undergoing RSI that are associated with the receipt and timing of post-intubation ventilation, analgesia, and sedation in a Pediatric ED.

Design/Methods: Our study included patients < 21 years undergoing RSI in a high-volume level-1 pediatric trauma center from 11/2018-6/2023. We excluded patients intubated prior to arrival or expired in the ED. Encounter characteristics were summarized as n (%) or median [IQR]. Outcomes in the ED were: (1) any post-intubation analgesia and sedation (received yes/no); (2) MV (initiated yes/no); (3) time to post-intubation analgesia and sedation (PIAS) or MV ( < 30 minutes/> 30 minutes). Individual and adjusted effects of predictors (age, sex, race, insurance, disposition, complex chronic conditions, ED length of stay (LOS), and indication for intubation) were assessed using Fisher’s exact tests and multivariate logistic regression.

Results: 685 children met inclusion criteria with the following characteristics: 1.5 [7.8] years old; 373 (54.5%) males; 392 (57.2%) white; 141 (20.6%) trauma (table 1). Overall, 408/685 (59.6%) received PIAS in the ED and MV was initiated for 412/685 (60.1%). Few patients received PIAS or MV in < 30 minutes, median time of 44 minutes [34] and 41.5 minutes [45.8] respectively. On univariate analysis, several factors were associated with receipt of PIAS within 30 minutes (table 2). In the multivariate model, only ED LOS < 60 minutes remained significantly associated with PIAS, aOR 3.49 [1.86, 6.57]. For MV initiation, ED LOS and indication for intubation were associated, p<.001. On modeling, no predictors were associated with initiating MV < 30 minutes.

Conclusion(s): After standard RSI, < 60% of children in this cohort received analgesia and sedation and only 60% were placed on MV in the ED. Neither were timely. These findings suggest that further evaluations informing practice improvements are highly warranted.