Impact of Intubation Location on Deep Sedation in the First 24 Hours of Medical ICU Care

Objectives Evaluate the association between intubation location (within the ICU vs outside the ICU) and early sedation practices, specifically sedation depth and medication exposure during the first 24 h of care and subsequent patient outcomes. Methods We performed a single- center, retrospective cohort study in a medical ICU at a tertiary academic medical center. Included patients were adults requiring mechanical ventilation, receiving continuous infusion sedatives for >24 h. Exclusion criteria during the first 24 h: death, end of life care, neuromuscular blocking agents beyond intubation, alcohol withdrawal syndrome, ST-elevation or Type-1 non-ST elevation myocardial infarction, targeted temperature management, seizure, or intracranial pressure monitoring. Results Two hundred-thirty patients were included. Sixty-eight patients (29.6%) were intubated in the ICU and 162 (70.4%) were intubated outside the ICU. Patients intubated in the ICU had an initial RASS score of −4 (IQR −4 to −2) versus −3 (IQR −4 to −2) in the outside of ICU intubation group ( P = .44). The total time in deep sedation during the first 24 h was 16.8 h (IQR 11.6-21.8) versus 12 h (IQR 6.7-20) respectively ( P = .02). There was no difference in sedative use or sedation exposure between cohorts. Duration of mechanical ventilation ( P = .65), hospital ( P = .05) and ICU length of stay ( P = .19) showed no difference. Illness severity scores were no different between cohorts on admission ( P = .28); however, intubation in the ICU had higher ICU (45.6% vs 20.4%, P < .001) and hospital (32.4% vs 13.6%, P < .001) mortality. Conclusions Location of intubation was not associated with depth of sedation or medication exposure during the first 24 h of ICU care.