Delayed Intubation Rarely Needed for Opioid Overdose in ED

TOPLINE:

Patients presenting to the emergency department (ED) with presumed opioid overdoses rarely needed delayed intubation, suggesting that these patients may be safely managed outside of an intensive care unit after 4 hours of ED monitoring.

METHODOLOGY:

• This secondary analysis of the Fentalog Study included 1591 patients with suspected acute opioid overdose who presented to EDs in the United States.
• Suspected opioid overdose was identified through opioid toxicity diagnoses, naloxone administration, or self-reported opioid use resulting in the ED visit.
• The primary outcome was the proportion of patients who received delayed intubation following suspected opioid overdose, with delayed intubation defined as endotracheal intubation occurring more than 4 hours after arrival at a hospital.

TAKEAWAY:

• Overall, only nine patients required delayed intubation.
• Eight of the nine patients who required delayed intubation had indications for intubation other than hypoventilation-induced respiratory failure.
• Naloxone was administered to seven patients with delayed intubation, with four patients receiving three or more doses.
• Only one patient who required delayed intubation due to hypoventilation received five doses of naloxone (a total of 6.4 mg).

IN PRACTICE:

“In conclusion, this study found an extremely low rate of patients requiring intubation for respiratory failure after 4 hours of monitoring, provided they initially presented with presumed opioid overdose. The low rate of delayed intervention (delayed intubation) suggests that opioid overdose disposition should continue to be based on comprehensive clinical assessments and ongoing reassessments, emphasizing the efficient use of resources,” the authors wrote.

SOURCE:

This study was led by Daniel J. McCabe, MD, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. It was published online on March 04, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

Although data were collected from several sites, they were not nationally representative, potentially limiting generalizability. The small number of patients with delayed intubation restricted the statistical analyses in this study. The exclusion of a significant proportion of patients from the Fentalog Study could have introduced bias to all subsequent secondary analyses.

DISCLOSURES:

This study received support from the National Institute on Drug Abuse of the National Institutes of Health. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.