In this episode, I’ll discuss how getting the depth of sedation correct in the ED might reduce mortality rates by half.
A group of researchers from Washington University School of Medicine in St. Louis just published a prospective before-after pilot and feasibility trial of an educational initiative aimed at instituting reliable ED sedation depth documentation and reducing the proportion of deeply sedated patients.
The final analysis of the study population included 415 patients across 3 medical centers.
The proportion of deeply sedated patients was reduced from 60.2% in the pre-intervention group to 38.8% post-intervention. This difference was statistically significant, as was the difference in 3 other areas:
Ventilator-free days were increased by 1.6 in the intervention group.
ICU-free days were increased by 2.7 in the intervention group.
The mortality rate was cut in half in the intervention group, from 20% down to 10%.
This trial was intended as a feasibility study to justify a larger trial, but it has produced some very encouraging results.
I have noticed in my practice that care started in the ED, whether it represents correct treatment or not, is likely to be continued upon hospital admission.
For example:
If the first dose of vancomycin given in the ED is 1g, then the admission order for vancomycin is likely to be 1g q12.
If phenylephrine is started for hypotension from septic shock, this is likely to continue through ICU admission despite norepinephrine being the preferred vasopressor.
That could explain the positive results of this study – light sedation started in the ED could mean that a light sedation level is more likely to be maintained through the ICU stay and confer the benefits expected when deep sedation is avoided.
In addition to suggesting the role for light sedation in the ED, this study can also be used to justify the value of a pharmacist in the ED.
Members of my Hospital Pharmacy Academy have access to several practical training videos that I have created on the use of sedation for critically ill patients. You can get immediate access to these and hundreds of other trainings and resources to help in your practice at pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply