Administration of Post-intubation Analgesia and Sedation in Injured Patients in New Brunswick EDs

Background Despite established guidelines emphasizing the importance of post-intubation analgesia and sedation in trauma patients, adherence remains suboptimal. The goal of this study was to understand the association between appropriate post-intubation sedation and analgesia infusions received by injured and intubated adult patients in New Brunswick (NB) before and after the introduction of a provincial guideline and educational intervention. Methods We conducted a retrospective cohort study using data from the NB Trauma Registry, analyzing 202 ED-intubated adult trauma patients (mean age, 46 years; 78% male) treated at Level 1-3 and 5 centers. The primary outcome was the proportion of patients receiving both analgesia and sedation prior to the creation and implementation of the Trauma NB consensus statement, Adult Rapid Sequence Intubation and Post-Intubation Analgesia and Sedation for Major Trauma Patients, and the subsequent educational intervention. We chose 2017 as the pre-intervention period, 2019 as the post-intervention period, and 2021 as the follow-up period. Secondary outcomes included whether no infusions were given, only analgesia was given, or only sedation was given. Results A total of 202 intubated adult trauma patients were included: 62 pre-intervention (2017), 72 post-intervention (2019), and 68 at follow-up (2021). The cohort had a mean age of 46 years and was predominantly male (78%). Motor vehicle collisions (51.5%) and falls (20.3%) were the most common mechanisms of injury, with a mean pre-intubation Glasgow Coma Scale score of 9. The proportion of patients receiving both analgesia and sedation increased significantly from 22.6% (95% CI, 13.8-34.5%) in 2017 to 61.1% (49.6-71.6%) in 2019 and 73.5% (61.9-82.6%) in 2021, representing a 3.3-fold improvement (p < 0.05). Omission of both therapies declined from 41.9% (30.4-54.3%) pre-intervention to 16.7% (9.6-27.1%) post-intervention and 8.8% (3.8-18.3%) at follow-up (p < 0.05). Sedation-only use decreased from 30.7% (20.5-43.0%) to 13.9% (7.5-23.9%) and 8.8% (3.8-18.3%), while analgesia-only use remained uncommon (4.8-8.8%). Conclusions Province-wide guideline implementation and educational intervention were associated with improved adherence to evidence-based post-intubation pharmacotherapy, with sustained effects at three-year follow-up. These findings suggest that standardized protocols and educational interventions may be effective tools for improving the quality of trauma airway management.