title: Single-drug sedation with fentanyl for prehospital postintubation sedation in trauma patients.
abstract: BACKGROUND
  A fentanyl-only (FO) regimen for prehospital postintubation sedation in trauma patients was compared with the standard protocol (SP) of fentanyl + benzodiazepine.
  
  
  METHODS
  Intubated patients transported to a Level I trauma center from December 1, 2005, to April 30, 2009, were retrospectively reviewed. Before 2007, only SP was used; afterward both regimens were used. Groups were compared for hemodynamic and neurologic parameters in the prehospital setting and trauma bay, fluid volumes, time until general or neurosurgical intervention (NSI), and other outcomes.
  
  
  RESULTS
  Groups were comparable with respect to age, sex, mechanism, alcohol level, intensive care unit length of stay, and hospital length of stay. Comorbidities were similar except hypertension (p = 0.019), and stroke (p = 0.029) were more frequent in FO patients. Prehospital heart rate and Glasgow Coma Scale (GCS) were similar. Trauma bay hemodynamic parameters and fluid resuscitation volumes were comparable, but pupil nonreactivity was more frequent in the FO group both overall (p = 0.032) and when comparing only patients with traumatic brain injury (TBI; p = 0.014). The incidence of TBI was comparable. Although the frequency of craniotomy (13% FO vs. 7% SP) and mortality (17% FO vs. 11% SP) were not statistically different overall, in patients with TBI, there was a higher incidence of NSI (28% vs. 14%, p = 0.015), craniotomy (14% vs. 3%, p = 0.02), and time to initial NSI (446 minutes vs. 193 minutes, p = 0.042) in the FO patients.
  
  
  CONCLUSIONS
  In this study, an FO regimen was associated with similar hemodynamic but worse neurologic variables compared with the SP regimen. Prospective evaluation is warranted before adoption of this regimen, especially in TBI patients.
authors.affiliation: Inova Regional Trauma Center, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA. christopher.michetti@inova.org
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Michetti
authors.forename: John F
authors.initials: JF
authors.lastname: Maguire
authors.forename: Aditya
authors.initials: A
authors.lastname: Kaushik
authors.forename: Ranjit R
authors.initials: RR
authors.lastname: Pullarkat
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Boro
authors.forename: Anne G
authors.initials: AG
authors.lastname: Rizzo
authors.forename: Hani
authors.initials: H
authors.lastname: Seoudi
authors.forename: Melody
authors.initials: M
authors.lastname: Meehan
authors.forename: Linda
authors.initials: L
authors.lastname: Robinson
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage; D001930:Brain Injuries / Q000628:therapy; D016292:Procedural Sedation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007442:Intubation, Intratracheal / Q000379:methods; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D005283:Fentanyl