A transfer-service audit described rescue boluses and infusion practices, while missing assessment data limited conclusions about adequate sedation.
What the source reports
The South African retrospective sample included 158 mechanically ventilated adult transfers. Twenty-two patients received rescue sedation, most commonly ketamine. Ketamine–midazolam combinations were frequent continuous regimens. Neuromuscular-blocker use was associated with rescue administration, but no sedation-depth or pain assessments were documented in the patient-care records.
Limits and uncertainty
One service’s records may be incomplete and may not generalize to other transport systems. A rescue bolus is not itself proof of undertreatment, awareness or an adverse event. Dose categories based on guidance cannot substitute for a documented patient response. Absence of an assessment entry does not prove that no clinical assessment occurred.
Implications for forensic review
For transport review, distinguish paralysis from sedation and analgesia. Reconstruct pre-transfer drugs, infusion continuity, observed responses and handover information. The audit highlights a documentation gap that matters for later interpretation, without establishing that a particular midazolam regimen was adequate or inadequate from dose alone.
Source and related reading
Source reviewed: Rescue sedation administered to mechanically ventilated patients undergoing interhospital transfer b (PMC13053836). Forensic applications above are interpretive analysis of the supplied paper.
Related reading: Dominant Midazolam Sedation Was Associated With ICU Delirium in a Matched Cohort.
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