Proportion of intensive care unit patients receiving sedation after rapid sequence intubation with rocuronium

Background: Rocuronium has a longer duration of action compared to the sedative effects of induction agents used during rapid sequence intubation (RSI), introducing a potential window for inadequate sedation.When rocuronium is used for paralysis in the emergency department, delays in sedation have been observed, but have not been described in Intensive Care Units (ICUs).Objectives: The primary objective is the proportion of patients in the ICU who received sedation within 15 minutes following intubation using rocuronium.Secondary objectives include 1) time to sedation (minutes), 2) time to sedation between ICUs (minutes), 3) time to sedation between provider specialties (minutes), 4) time to sedation by Glasgow Coma Scale (GCS), and 5) first-hour vs second-hour Sedation Intensity Score (SIS) post-RSI.Methods: This is a retrospective review at a single academic tertiary care center of patients intubated in an ICU between July 2019 and August 2020.Inclusion criteria were age 18-89 years, intubation using rocuronium, and intubation in an ICU.Exclusion criteria were sedative exposure prior to intubation, no charted induction agent or charting delays from paralytic, incomplete charting, intubation outside an ICU, intubation during cardiac arrest, pregnancy, or incarceration.Results: 192 intubations using rocuronium were included and 77 (40.1%) received sedation within 15 minutes of induction agent administration.There was no difference in proportion of patients receiving sedation by GCS ≤ 8 and GCS > 8 prior to intubation (38.1% vs 41.1%, p=0.69).Using a SIS to describe amount of sedative administered, more sedation was administered in the second hour after intubation compared to the first hour (median score 5.5 IQR 0-20 vs. 4.5 0-12.5,p<0.001). Conclusion:In this single center analysis, a large proportion of patients intubated in ICUs with rocuronium did not receive additional sedation within 15 minutes of induction, exposing them to risk of awareness while paralyzed.