A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service

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dc.contributor.advisorStassen, Willem
dc.contributor.advisorBuma, Chloe Ashton
dc.contributor.authorde Kock, Joalda Marthiné
dc.date.accessioned2022-01-20T12:42:18Z
dc.date.available2022-01-20T12:42:18Z
dc.date.issued2021
dc.date.updated2022-01-20T09:30:00Z
dc.description.abstractIntroduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.
dc.identifier.apacitationde Kock, J. M. (2021). <i>A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service</i>. (). ,Faculty of Health Sciences ,Division of General Surgery. Retrieved from http://hdl.handle.net/11427/35543en_ZA
dc.identifier.chicagocitationde Kock, Joalda Marthiné. <i>"A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service."</i> ., ,Faculty of Health Sciences ,Division of General Surgery, 2021. http://hdl.handle.net/11427/35543en_ZA
dc.identifier.citationde Kock, J.M. 2021. A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service. . ,Faculty of Health Sciences ,Division of General Surgery. http://hdl.handle.net/11427/35543en_ZA
dc.identifier.ris TY - Master Thesis AU - de Kock, Joalda Marthiné AB - Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions. DA - 2021_ DB - OpenUCT DP - University of Cape Town KW - Endotracheal intubation KW - Emergency Medical Services KW - Post-intubation KW - Sedation and Analgesia LK - https://open.uct.ac.za PY - 2021 T1 - A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service TI - A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service UR - http://hdl.handle.net/11427/35543 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/35543
dc.identifier.vancouvercitationde Kock JM. A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service. []. ,Faculty of Health Sciences ,Division of General Surgery, 2021 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/35543en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDivision of General Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.subjectEndotracheal intubation
dc.subjectEmergency Medical Services
dc.subjectPost-intubation
dc.subjectSedation and Analgesia
dc.titleA retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPhil
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