Objectives/Goals: The emergency department (ED) is a critical locus of care for mechanically ventilated patients. Emergency physician (EP) perceptions and decision-making on sedation for these patients have not been studied. We seek to characterize EP decision-making on sedatives. Methods/Study Population: This is a preliminary report of a single-center survey study. We surveyed senior residents and attending EP scaring for patients enrolled in an ongoing prospective cohort study of ED sedation. Surveys were delivered electronically. Respondents were asked to provide demographics, impressions effectiveness of the sedative infusions they administered, occurrence of related adverse events (AE), and ranking of factors influencing their decision-making. Respondents were also asked if they considered using other sedative infusions (propofol PRO, fentanyl FENT, dexmedetomidine DEX, ketamine KET, and midazolam MDZ), and why they chose not to use them. The use of bolus-dose sedatives was not assessed. Results/Anticipated Results: From October 2024 through September 2025, 174 surveys were sent and 127 completed (73%). PRO was most commonly used (94%), followed by FENT (51%) and DEX (14%). Effectiveness was highest for PRO (84% “somewhat” or “very” effective; FENT 75%, DEX 72%). The leading AE was hypotension (PRO 32%, DEX 17%). Effectiveness was the most important decision-making factor, familiarity the least. DEX, FENT, KET, and MDZ were considered but not used in about 25% of cases. Emerging themes from free-text comments included perception of under-sedation as an AE and influence of medication accessibility. Discussion/Significance of Impact: EPs perceive PRO as effective but associated with frequent AE, usually hypotension. Perceived effectiveness drives sedative selection. Our findings will inform the design of interventions to optimize ED sedation.
Baumgartner et al. (Wed,) studied this question.
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