MedStar Authors catalog › Details for: Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED.
Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED. Journal: The American journal of emergency medicine.Published: 2016ISSN: 0735-6757.UI/PMID: 27727068.Subject(s): Adult | Body Mass Index | Databases, Factual | Emergency Service, Hospital | *Etomidate/ad [Administration & Dosage] | Female | Humans | *Hypnotics and Sedatives/ad [Administration & Dosage] | *Intubation, Intratracheal | Logistic Models | Male | *Medication Errors | Middle Aged | *Obesity/co [Complications] | Retrospective Studies | *Succinylcholine/ad [Administration & Dosage]=520 \\ OBJECTIVE: There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patientsInstitution(s): MedStar Washington Hospital Center | MedStar Health Research InstituteDepartment(s): Emergency MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.ajem.2016.09.056 (Click here) Abbreviated citation: Am J Emerg Med. 34(12):2423-2425, 2016 Dec.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: METHODS: Retrospective review using a database of endotracheally intubated patients using RSI in an urban, tertiary care academic emergency department, from November 2009 to June 2011. Dosing for succinylcholine and etomidate was calculated as milligrams per kilogram of total body weight (TBW) for each patient, defining appropriate dosing as succinylcholine 1-1.5 mg/kg TBW and etomidate 0.2-0.4 mg/kg TBW. Logistic regression analysis was used to estimate the association between appropriate dosing and World Health Organization body mass index classification.Abstract: RESULTS: A total of 440 patients were included in the study, 311 (70.7%) classified as nonobese and 129 (29.3%) as obese. two hundred thirty-three (56%) received an inappropriate succinylcholine dose and 107 (24%) received an inappropriate etomidate dose. Obese patients were more likely to be underdosed with succinylcholine (odds ratio [OR], 63.7; 95% confidence interval [CI], 17.8-228.1) and etomidate (OR, 178.3; 95% CI, 37.6-844.7). Nonobese patients were more likely to be overdosed with succinylcholine (OR, 62.5; 95% CI, 17.9-250) and etomidate (OR, 166.7; 95% CI, 37.0-1000).Abstract: CONCLUSION: Obese patients were more likely to be underdosed during RSI compared with nonobese patients, whereas nonobese patients were more likely to be overdosed with RSI medications. Most obese and nonobese patients were inappropriately dosed with RSI medications, suggesting that physicians are not dosing these medications based on weight.Abstract: Copyright � 2016 Elsevier Inc. All rights reserved.