Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients *.
Nieszkowska, Ania MD; Combes, Alain MD, PhD; Luyt, Charles-Edouard MD, PhD; Ksibi, Hichem MD; Trouillet, Jean-Louis MD; Gibert, Claude MD; Chastre, Jean MD
Critical Care Medicine.
33(11):2527-2533, November 2005.
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Objective: To assess the impact of tracheotomy on sedative administration, sedation level, and autonomy of mechanically-ventilated intensive care unit (ICU) patients.
Design, Setting, and Patients: In this observational study, the charts of all consecutive patients undergoing mechanical ventilation requiring tracheotomy over a 14-month period in our 18-bed tertiary care ICU were reviewed retrospectively. Patients' sedation levels (according to the Riker's 7-level sedation-agitation score) and intravenous (fentanyl and midazolam) and oral (clorazepate and haloperidol) sedative administration were measured daily during the 7 days before and after tracheotomy. We also recorded patients for whom chair positioning and oral alimentation became possible in the days following tracheotomy.
Measurements and Main Results: Tracheotomy was performed on 72 (23.1%) of the 312 patients undergoing mechanical ventilation for >=48 hrs. After tracheotomy, median (25th, 75th percentiles) fentanyl and midazolam administration decreased from 866 (191, 1672) to 71 (3, 426) [mu]g/(patient[middle dot]day) and from 44 (16, 128) to 7 (1, 42) mg/(patient[middle dot]day) (p < .001), respectively. Concomitant median time spent heavily sedated decreased from 7 (3, 17) to 1 (0, 6) hrs/day (p < .001), with no increase in agitation time. During the 7 days following tracheotomy, partial oral alimentation became possible for 35 patients (48.6%) and out-of-bed positioning became possible for 16 patients (22.2%).
Conclusion: On the basis of these observations, we conclude that tracheotomized mechanically ventilated ICU patients required less intravenous sedative administration, spent less time heavily sedated, and achieved more autonomy earlier.
(C) 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins