(771) Intubation Incidence in Patients Treated With Benzodiazepine for Status Epilepticus

Introduction: Guidelines recommend first-line treatment for status epilepticus with either midazolam, lorazepam, or diazepam. The efficacy of benzodiazepines as a first-line treatment has been established. However, there is often fear to utilize the full dosage of these medications due to the risk of respiratory depression and sedation requiring invasive mechanical ventilation. A recent registry review showed that the guideline recommended doses of benzodiazepine agents for the treatment of status epilepticus was only utilized 29% of the time. Yet, there is little data on how dosing impacts safety. The goal of this study is to determine if there is an association with benzodiazepine dose and incidence of intubation.

Methods: This was a retrospective cohort study. Patients were eligible for inclusion if they were less than 100 years old, admitted to the emergency department from June 2016 to June 2023 with an ICD-10 diagnosis of status epilepticus, and received one of the first-line agents for the treatment of status epilepticus: midazolam, lorazepam, or diazepam. Patients were excluded if they were transferred from an outside facility, intubated prior to treatment, or intubated for a procedure or surgical intervention. The primary outcome was the incidence of intubation following benzodiazepine administration. The primary outcome was considered to have occurred if intubation happened within 35 min of the administration of a benzodiazepine. Secondary outcomes include hospital and ICU length of stay, and duration of invasive mechanical respiratory support.

Results: 642 patients were screened with 450 being included. A total of 154 (34%) patients received the guideline recommended dose of a benzodiazepine. A total of 88 (19.5%) patients were intubated, 27 (17.5%) in the guideline recommended group and 61 (20.6%) in the non-guideline group (p=0.432). There were no significant differences in length of stay, duration of invasive mechanical respiratory support, or ICU length of stay.

Conclusions: The results of this analysis showed no statistically significant difference in the rate of intubation in patients who received guideline recommended benzodiazepine dose for status epilepticus compared to those who did not. these results support the safety of guideline recommended dosing for status epilepticus.