Name: Resident Presentation - Yurim Lee
Start: 2026-04-30T17:00:00-0400
End: 2026-04-30T17:20:00-0400

Resident Presentation - Yurim Lee

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Olympia 2

Title: Impact of Sedation Protocol Changes on Restraint Use:   A Pre-Post Analysis of Weight-Based Dosing Adjustment in the Emergency Department
Authors: Yurim Lee, Carrie Baker
Practice Site: Wellstar Kennestone Regional Medical Center, Marietta, GA

Background: Wellstar Kennestone Regional Medical Center (WKRMC) recently implemented a sedation protocol in which initial fentanyl and propofol infusion doses for mechanically ventilated patients are calculated using ideal body weight (IBW), replacing the previous strategy of non-weight-based fentanyl and total body weight-based propofol dosing. Anecdotally, emergency department (ED) staff have observed an increase in the use of physical restraints among mechanically ventilated patients following this change. This study was conducted to assess the impact of protocol change on sedation adequacy by examining physical restraint use in mechanical ventilated (MV) patients. Physical restraint use was selected as a pragmatic surrogate measure for inadequate sedation in the ED.
Methods: A single-center retrospective chart review was conducted at WKRMC. Adults ≥18 years who were MV in the ED and received continuous fentanyl or propofol as initial sedation were identified through Epic SlicerDicer and stratified into pre-implementation and post-implementation groups. Protocol adherence was defined as initiation and titration of sedation infusions according to the institutional sedation protocol, including appropriate weight selection and protocol-guided titration intervals. Patients were excluded if they were intubated prior to ED arrival, had restraints applied before intubation, had a Glasgow Coma Scale score of 3 throughout the ED stay, had an ED length of stay ≤1 hour, were pregnant, or arrived in cardiac arrest and expired in the ED. The primary outcome was the frequency of restraint use within 12 hours after intubation or until ICU transfer, whichever occurred first. The secondary outcome was the total dose of adjunctive sedatives administered within the first 12 hours after intubation or until ICU transfer, whichever occurred first, to evaluate the adequacy of initial continuous infusion sedation. Data was collected and analyzed using Microsoft Excel.
Results: A total of 247 patients were screened, and 50 patients per group were included in the analysis. Baseline demographics, comorbidities, and indications for intubation were similar between the two groups. Restraint use within the first 12 hours after intubation or until ICU transfer occurred in 32% of patients in the pre-implementation group compared with 26% in the post-implementation group. All restraints applied were soft restraints. Protocol adherence occurred in only 54% of pre-implementation patients and 42% of post-implementation patients. When sedation was protocol-adherent, restraint utilization was similar between groups (25.9% vs 23.8%). Among non-protocol-adherent cases, restraint use was higher in the pre-implementation group than in the post-implementation group (39.1% vs 27.6%). Adjunctive sedatives were used in 64% of pre-implementation patients and 58% of post-implementation patients. Benzodiazepines were the most common adjunctive agents used. The mean benzodiazepine-equivalent dose was substantially higher in the pre-implementation group (22.72 mg vs 7.78 mg). Dexmedetomidine and ketamine were also used more frequently in the pre-implementation group. Overall, sedative exposure was higher in the pre-implementation cohort.
Conclusions: Implementation of an IBW–based sedation protocol in MV ED patients was not associated with increased restraint use or greater adjunctive sedative requirements. Despite lower calculated infusion doses, the new weight-based protocol appeared to provide adequate early sedation and may reduce the need for additional sedative escalation. However, several limitations should be considered. Protocol deviations and inconsistent titration practices were frequently observed and likely contributed to variability in sedation management and restraint utilization. These findings suggest that adherence to standardized sedation protocols, including appropriate weight selection and protocol-guided titration, may play a more important role in achieving adequate sedation than the dosing strategy alone. The results highlight opportunities to improve sedation practices and documentation workflows in the ED, particularly during emergent intubation when medication administration may be documented after the fact. Routine auditing and feedback may help improve protocol adherence and support sustained practice improvement.

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Moderators

Yurim Lee

PGY1 Pharmacy Resident, Wellstar Kennestone Regional Medical Center

Kristy (Yurim) Lee, PharmD, was born in South Korea and raised in College Station, Texas. She earned her Bachelor of Science in Biology from the University of Texas at Austin and her Doctor of Pharmacy degree from the Texas A&M University Irma Lerma Rangel College of Pharmacy. Dr... Read More →

Evaluators

Marci Swanson

Clinical Pharmacist Practitioner, Carl Vinson VA Medical Center

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Olympia 2

Critical Care/Emergency Medicine (CCM), Wellstar Kennestone Regional Medical Center

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2026 Southeastern Residency Conference

Krista Dumkow

Yurim Lee

Marci Swanson

Attendees (12)

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2026 Southeastern Residency Conference

Krista Dumkow

Yurim Lee

Marci Swanson

Attendees (12)

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