Choice of Postintubation Sedation Strategy by Sex: A Conjoint Analysis

Purpose: To assess if patient sex is an important attribute in physician decision-making for postintubation sedation strategies in the emergency department and intensive care units.

Methods: We designed a survey of eight fictional cases utilizing a fractional factorial design varying fictional patient sex, race/ethnicity, and history of substance use disorder. We surveyed emergency medicine and critical care fellows and attendings at three geographically diverse academic medical centers in the US. We analyzed data using conjoint analysis to assess importance weights (IW). For this analysis, we compared physician beliefs of stated importance of sex to IW derived from cases.

Findings: Eighty-six participants started the survey; 75 (87.2%) participants completed demographic information and at least one vignette and were included in analysis. Most physicians were white, male, worked primarily in an emergency department and were attending physicians. Sex had the lowest weight in affecting decisions when considering using midazolam (IW = 3.2%) or propofol (IW = 3.6%) as postintubation sedation strategies, and the second lowest weight when considering fentanyl (IW = 7.3%). Respondents stated they believed physicians rarely considered patient sex when making decisions about postintubation sedation.

Implications: Physicians managing postintubation sedation reported sex rarely affected decision-making when choosing propofol, midazolam, or fentanyl as sedation strategies, despite evidence that these medications are metabolized differently in females. Further research is needed to identify ideal postintubation sedation strategies that account for patient sex.