Risk of Delayed Intubation After Presumed Opioid Overdose in the Emergency Department.

The study in question aimed to investigate the optimal duration of monitoring for patients who have experienced a presumed opioid overdose, with a focus on those who do not require admission to an intensive care unit (ICU). This is a critical area of research, particularly given the increasing prevalence of potent synthetic opioids such as fentanyl analogs. The study is part of a larger project known as the Fentalog Study, which is a prospective, multi-institutional effort conducted through the American College of Medical Toxicology's Toxicology Investigators Consortium. The primary goal of the Fentalog Study is to gather clinical details and confirm substances through biologic testing for patients presenting to the emergency department with acute opioid overdose. The specific analysis in question focused on the risk of "delayed intubation," which is defined as any intubation that occurs after 4 hours of arrival to the emergency department. The study found that among the 1,591 patients included, only 9 (or 0.6%) required delayed intubation. Notably, 8 of these patients had non-respiratory-related conditions that contributed to the need for intubation, while only 1 patient had respiratory-related conditions that led to intubation. This patient had respiratory acidosis and received a total of 6.4 mg of naloxone before intubation. The study's findings suggest that delayed intubation after 4 hours of monitoring in patients with presumed opioid overdose is extremely rare, occurring in less than 1% of cases. These results can inform clinical decision-making regarding patient disposition after initial overdose treatment, providing valuable guidance for emergency physicians managing opioid overdose cases. Overall, the study contributes to a better understanding of the optimal management of patients with opioid overdoses and can help improve patient outcomes. Link: https://pubmed.ncbi.nlm.nih.gov/40047773/