Was the introduction of a provincially standardized consensus statement for postintubation analgesia and sedation associated with increased use of associated pharmacological therapies in New Brunswick?

Background: The NB Trauma Program (NBTP) introduced the "Adult Rapid Sequence Intubation and Post-Intubation Analgesia and Sedation for Major Trauma Patients" consensus statement across New Brunswick emergency departments (EDs) in 2018. The consensus statement included checklists, tools and educational support. This review's purpose was to use NB Trauma Registry (NBTR) data to evaluate whether the provincial consensus statement and related support was associated with improved postintubation pharmacological support among intubated trauma patients across New Brunswick. Methods: Postintubation analgesia and sedation infusions while in an ED are captured within the NBTR. Data were extracted for the year before and the year after provincial consensus statement implementation. All patients with intubation listed as an ED procedure were included. Patients who died, had cardiopulmonary resuscitation or were extubated, as well as 1 case intubated for a nontrauma reason, were all excluded. Data were reviewed to determine if they had either, both or no postintubation infusions. Results: In 2017 (before the implementation of the consensus statement and related support), 41% of patients received neither analgesia nor sedation infusions. Only 27% of patients received an analgesia infusion either alone or in combination with a sedation infusion. Sedation infusions only were noted in 32% of patients. In 2019 (the year following the release of the consensus statement and related support), only 17% of patients received neither analgesia nor sedation infusions, an absolute reduction of 24%. There was a 43% increase in patients receiving an analgesia infusion either alone or in combination with sedation. Sedation-only infusions were reduced by 19%. Perhaps most importantly, the percentage of patients receiving both recommended infusions increased from 22% to 61%. Conclusion: Introduction of a provincial consensus statement, together with supporting tools and checklists, was associated with substantially higher use of both sedation and analgesia postintubation infusions across NB trauma centres. Use of continuous analgesia increased from 27% to 70%, while use of both continuous analgesia and sedation increased from 22% to 61%. These changes represent tangible improvement in the care of intubated trauma patients. Continued application of the consensus statement methodology, including related supports, is encouraged.